30/01/2026
The Threshold Problem: Why Vestibular Migraine is Never "Just" Vertigo.
One of the most frustrating things for clinicians—and patients—is the inconsistency of symptoms. A patient might handle a car ride fine on Monday, but be bedridden by a 10-minute drive on Wednesday.
This is the Threshold Concept. Vestibular Migraine isn't a "broken" part; it’s a system that has lost its reserve.
Think of it as a bucket. Poor sleep, a spike in histamine, a flicker of light, and a cervical subluxation all add "water" to the bucket. The vertigo only happens when the bucket overflows. If we only focus on the vestibular system (the "dizziness"), we’re only looking at the last drop of water, not the capacity of the bucket.
True functional management means increasing the size of that bucket through metabolic support while simultaneously "poking holes" in the bottom of it through neurological rehab.
Jake Cooke and I are sitting down this Sunday (Feb 1st) to map out this exact framework at the Beyond Migraine seminar. It’s our last session for a while on Vestibular Migraine, so if you’re looking to tie the metabolic and neurological pieces together, it’s a perfect time to join us.
When: Feb 1st 2026
Register at: www.beyondmigraine.co.uk/seminars