Grounded | The Vestibular Podcast

Vestibular disorders (particularly vestibular migraine) and POTS are often talked about in our practice and in Vestibular Group Fit as they overlap quite a bit.

In this episode, I’m digging into one of the most common co-occurring conditions I see in my practice alongside vestibular migraine: POTS (Postural Orthostatic Tachycardia Syndrome).

I’m also introducing something called the pentad super syndrome (almost every single person I see in my clinic has all five). You’ll learn what it is and what I believe is missing from the list.

Discover everything from how POTS is diagnosed, to helpful resources, and why your basics matter more than ever when you’re managing both POTS and vestibular disorders at the same time.

In this episode, we’ll dig into:

What POTS is

The diagnostic criteria for POTS

Why there is overlap between POTS and vestibular 

What the pentad super syndrome is

Why histamine and MCAS are a huge piece of the puzzle

The tilt table test vs. active stand test

What conditions can sometimes mimic POTS

What the CHOP POTS protocol is

Why heat is a major POTS and MCAS trigger

What tools to keep in your toolkit for heat

Lifestyle changes that are beneficial for POTS and vestibular conditions

How VGF members apply the threshold and bucket theory to manage both conditions

The good news is that the toolkit for your vestibular disorder and your POTS have a LOT of overlap, which means you’re already building the right foundation.

Related Episodes:

Build Your Migraine Threshold: https://thevertigodoctor.com/podcast/74-build-your-migraine-threshold-to-reduce-vestibular-migraine-attacks/

Links Mentioned:

Vestibular Group Fit (code GROUNDED at checkout for 15% off!): https://thevertigodoctor.com/vestibular-group-fit

Standing Up to POTS podcast: https://www.standinguptopots.org/podcast

dysautonomiaproject.org 

Santosha Spirit on YouTube (Rachel): https://www.youtube.com/channel/UC0ROkm_8Bjk0qOQ13XYOebg

Compression socks: https://sockwellusa.com/

NEWZILL Calf Compression Sleeve: https://www.amazon.com/NEWZILL-Calf-Compression-Sleeve-Footless/dp/B0DRYS7KBD/

Doc Miller Calf Compression Sleeves: https://www.amazon.com/Doc-Miller-Compression-20-30mmHg-Fashionable/dp/B012E1B5P6/

LMNT electrolytes: https://www.amazon.com/LMNT-Zero-Sugar-Electrolytes/dp/B084HQ4DYQ/

Free Resources:

⁠The 4 Steps to Managing Vestibular Migraine: https://thevertigodoctor.myflodesk.com/cb5js0y78n

⁠The PPPD Management Masterclass⁠: https://thevertigodoctor.myflodesk.com/new-pppd

⁠What your Partner Should Know About Living with Dizziness⁠: https://thevertigodoctor.myflodesk.com/partnership

⁠The FREE Mini VGFit Workout⁠: https://thevertigodoctor.myflodesk.com/minifit

⁠The FREE POTS – safe Workouts⁠: https://thevertigodoctor.myflodesk.com/pots

Connect with Dr. Madison (@TheVertigoDoctor): https://instagram.com/thevertigodoctor

Work with Dr. Madison:

For 1:1 Vestibular Rehabilitation Therapy, email madison@thevertigodoctor.com

Otherwise, I’ll see ya in Vestibular Group Fit!

Connect with Dr. Jenna (@dizzy.rehab.therapist): https://www.instagram.com/dizzy.rehab.therapist/

Learn about the Oak Method: http://thevertigodoctor.com/why-vestibular-group-fit

Love what you heard?
Consider leaving a review on your favorite podcast platform to help us reach more vestibular warriors like you!

This podcast is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here.

Citations

“Research Summary: Postural Orthostatic Tachycardia Syndrome (POTS)….” American Headache Society, 2022, americanheadachesociety.org/research/library/research-summary-postural-orthostatic-tachycardia-syndrome-pots-and-migraine-a-narrative-review.

Cleveland Clinic. “Postural Orthostatic Tachycardia Syndrome (POTS).” Cleveland Clinic, 9 Sept. 2022, my.clevelandclinic.org/health/diseases/16560-postural-orthostatic-tachycardia-syndrome-pots.

POTS and vestibular disorders, vestibular migraine, histamine and MCAS, chronic dizziness, PPPD, nervous system regulation for vestibular migraine, migraine management, stress relief, vestibular disorders, vestibular group fit, nervous system regulation, vestibular disorder treatment

You’ve probably heard the words ‘biofeedback’ and ‘neurofeedback’ floating around the internet. And you’re also probably wondering what they mean and if they’re worth your time and money when you have a vestibular disorder.

I’m answering all of that in this episode!

Biofeedback is a type of mind-body technique to control some of the body’s function. And neurofeedback is a type of biofeedback that measures and records brainwaves. As always, I’ve got research and scenarios for us to talk through to help this really land.

They’re probably not the first thing you want to invest in and there are even less expensive options that are equally or more effective which I share more about in the episode.

Buckle up and let’s get a little nerdy with this one!

In this episode, we’ll dig into:

What biofeedback is and how it works

What the main types of biofeedback are

What neurofeedback is and how it relates to biofeedback

The difference between active and passive neurofeedback

The two main models of biofeedback that exist

What to expect in a biofeedback session

What biofeedback is considered effective for

Types of neurofeedback and biofeedback sessions, devices, and apps available

How to find a qualified biofeedback provider

What questions to ask before committing to either option

If you want to go even deeper with what you heard in this episode, we have coaching calls specifically about biofeedback and neurofeedback available in Vestibular Group Fit.

Biofeedback is a tool, not a cure. But if you’re curious, informed, and financially comfortable exploring it, it absolutely can have a place in your vestibular toolkit.

Links Mentioned:

Vestibular Group Fit (code GROUNDED at checkout for 15% off!): https://thevertigodoctor.com/vestibular-group-fit

Certification from the Association for Applied Psychophysiology and Biofeedback (AAPB) site has an option to find a practitioner: https://aapb.org/Find_a_Practitioner 

Hearthmath: https://www.heartmath.com/ 

Resperate (FDA approved for blood pressure and stress): https://resperate.com 

Leva (FDA approved for pelvic floor): https://levacares.com/ 

Prism (FDA approved for PTSD): https://www.graymatters-health.com/prism-for-ptsd 

Finding a provider

International society for neuroregulation and research: https://isnr.org/

Biofeedback certification international alliance: https://www.bcia.org/

Free Resources:

⁠The 4 Steps to Managing Vestibular Migraine: https://thevertigodoctor.myflodesk.com/cb5js0y78n

⁠The PPPD Management Masterclass⁠: https://thevertigodoctor.myflodesk.com/new-pppd

⁠What your Partner Should Know About Living with Dizziness⁠: https://thevertigodoctor.myflodesk.com/partnership

⁠The FREE Mini VGFit Workout⁠: https://thevertigodoctor.myflodesk.com/minifit

⁠The FREE POTS – safe Workouts⁠: https://thevertigodoctor.myflodesk.com/pots

Connect with Dr. Madison (@TheVertigoDoctor): https://instagram.com/thevertigodoctor

Work with Dr. Madison:

For 1:1 Vestibular Rehabilitation Therapy, email madison@thevertigodoctor.com

Otherwise, I’ll see ya in Vestibular Group Fit!

Connect with Dr. Jenna (@dizzy.rehab.therapist): https://www.instagram.com/dizzy.rehab.therapist/

Learn about the Oak Method: http://thevertigodoctor.com/why-vestibular-group-fit

Love what you heard?
Consider leaving a review on your favorite podcast platform to help us reach more vestibular warriors like you!

This podcast is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here.

Citations

Frank, D. L., Khorshid, L., Kiffer, J. F., Moravec, C. S., & McKee, M. G. (2010). Biofeedback in medicine: who, when, why and how?. Mental health in family medicine, 7(2), 85–91.

Mayo Clinic. “Biofeedback – Mayo Clinic.” Mayoclinic.org, 18 Mar. 2023, www.mayoclinic.org/tests-procedures/biofeedback/about/pac-20384664.

Marzbani, H., Marateb, H. R., & Mansourian, M. (2016). Neurofeedback: A Comprehensive Review on System Design, Methodology and Clinical Applications. Basic and clinical neuroscience, 7(2), 143–158. https://doi.org/10.15412/J.BCN.03070208

Bazzana, F., Finzi, S., Di Fini, G., & Veglia, F. (2022). Infra-Low Frequency Neurofeedback: A Systematic Mixed Studies Review. Frontiers in human neuroscience, 16, 920659. https://doi.org/10.3389/fnhum.2022.920659

Duke, G., Yotter, C. N., Sharifian, B., Duke, G., & Petersen, S. (2024). The effectiveness of microcurrent neurofeedback on depression, anxiety, post-traumatic stress disorder, and quality of life. Journal of the American Association of Nurse Practitioners, 36(2), 100–109. https://doi.org/10.1097/JXX.0000000000000945

Cleveland Clinic. “Biofeedback: What Is It & Procedure Details.” Cleveland Clinic, 21 Dec. 2020, my.clevelandclinic.org/health/treatments/13354-biofeedback.

biofeedback and neurofeedback, biofeedback vs neurofeedback, vestibular group fit, VGF, vestibular disorders, chronic dizziness, PPPD, nervous system regulation, migraine management, stress relief, alternative therapies, holistic approach, living with vestibular migraine, living with vertigo, migraine toolkit, vestibular disorder treatment

One thing that a lot of people with vestibular disorders notice is how fatiguing or challenging different tasks become over time. 

What’s happening is your brain is trying to process multiple inputs (or even tasks) at the same time. 

For those with vestibular disorders, it becomes more difficult because your body is trying to process more information—and it’s also now having to work double time to keep you upright.

Multitasking and task switching are a part of daily life, but it comes with costs. And those with vestibular disorders often notice this more but aren’t quite sure how to make it go away.

But this episode is here to help!

In this episode, we’ll dig into:

Why tasks feel manageable alone but become overwhelming when combined

How multitasking and task switching are similar and different

What the “switch cost” is and how it adds up over time for those with vestibular disorders

What percentage of people with vestibular conditions experience cognitive symptoms like brain fog

How the central nervous system and cerebral cortices matter for cognitive symptoms

Why spatial awareness demands extra resources when you have a vestibular disorder

How balance exercises in VRT are designed to gradually scale up task demands

Why errors are actually part of healing with a vestibular condition

Why rest and recovery are essential when you’re adding in more cognitive or physical tasks

Task switching and multitasking are hard for everyone! A vestibular disorder just adds an extra layer—it doesn’t mean things can’t improve, but it does take time, space, and grace.

You’re doing more things than you think and certainly doing more than you take credit for.

Links Mentioned:

Vestibular Group Fit (code GROUNDED at checkout for 15% off!): https://thevertigodoctor.com/vestibular-group-fit

Free Resources:

⁠The 4 Steps to Managing Vestibular Migraine: https://thevertigodoctor.myflodesk.com/cb5js0y78n

⁠The PPPD Management Masterclass⁠: https://thevertigodoctor.myflodesk.com/new-pppd

⁠What your Partner Should Know About Living with Dizziness⁠: https://thevertigodoctor.myflodesk.com/partnership

⁠The FREE Mini VGFit Workout⁠: https://thevertigodoctor.myflodesk.com/minifit

⁠The FREE POTS – safe Workouts⁠: https://thevertigodoctor.myflodesk.com/pots

Connect with Dr. Madison (@TheVertigoDoctor): https://instagram.com/thevertigodoctor

Work with Dr. Madison:

For 1:1 Vestibular Rehabilitation Therapy, email madison@thevertigodoctor.com

Otherwise, I’ll see ya in Vestibular Group Fit!

Connect with Dr. Jenna (@dizzy.rehab.therapist): https://www.instagram.com/dizzy.rehab.therapist/

Learn about the Oak Method: http://thevertigodoctor.com/why-vestibular-group-fit

Love what you heard?
Consider leaving a review on your favorite podcast platform to help us reach more vestibular warriors like you!

This podcast is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here.

Citations 

McGrath, Kim. “The “Switch Cost” of Multitasking.” Wake Forest News, 16 Apr. 2024, news.wfu.edu/2024/04/16/the-switch-cost-of-multitasking/.

Asuako, P. A. G., Stojan, R., Bock, O., Mack, M., & Voelcker-Rehage, C. (2025). Multitasking: does task-switching add to the effect of dual-tasking on everyday-like driving behavior?. Cognitive research: principles and implications, 10(1), 5. https://doi.org/10.1186/s41235-025-00611-y

Smith, L. J., Wilkinson, D., Bodani, M., & Surenthiran, S. S. (2024). Cognition in vestibular disorders: state of the field, challenges, and priorities for the future. Frontiers in neurology, 15, 1159174. https://doi.org/10.3389/fneur.2024.1159174

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task switching and multitasking, things to help with brain fog, vestibular migraine brain fog, what causes brain fog and dizziness, vestibular disorders, vestibular group fit, living with vestibular migraine, living with chronic dizziness, sensory overload, spatial awareness, cognitive abilities

Heading somewhere with a big elevation change? Good news! Most people living with vestibular disorders actually do really well at altitude. But that doesn’t mean you just show up unprepared and hope for the best.

In this episode, I’m breaking down everything you need to know about navigating altitude changes with a vestibular disorder. 

From quick pressure shifts like takeoff and landing, to extended stays at higher elevations, I’m sharing what to keep on standby, what to avoid, and why slower adjustments make all the difference.

In this episode, we’ll dig into:

Why most people with vestibular disorders actually feel good at altitude

Tools for quick pressure changes like takeoff, landing, and steep elevation drives

The difference between earplanes & WeatherX earplugs

Why slower ascents make a huge difference and how to pace your elevation

Medications to ask your doctor about before travel

Why you most definitely want to rethink alcohol at elevation

What self-care tips still apply at altitude

The research behind nature being great for your nervous system

My thoughts on oxygen bars and vestibular disorders

Altitude changes don’t have to derail your trip! With the right prep, the right toolkit, and a slower ascent, you absolutely can enjoy the mountain tops.

Links Mentioned:

Vestibular Group Fit (code GROUNDED at checkout for 15% off!): https://thevertigodoctor.com/vestibular-group-fit

WeatherX Earplugs: https://amzn.to/4h7Py7N

Earplanes: https://amzn.to/4aQji5b

Free Resources:

⁠The 4 Steps to Managing Vestibular Migraine: https://thevertigodoctor.myflodesk.com/cb5js0y78n

⁠The PPPD Management Masterclass⁠: https://thevertigodoctor.myflodesk.com/new-pppd

⁠What your Partner Should Know About Living with Dizziness⁠: https://thevertigodoctor.myflodesk.com/partnership

⁠The FREE Mini VGFit Workout⁠: https://thevertigodoctor.myflodesk.com/minifit

⁠The FREE POTS – safe Workouts⁠: https://thevertigodoctor.myflodesk.com/pots

Connect with Dr. Madison (@TheVertigoDoctor): https://instagram.com/thevertigodoctor

Work with Dr. Madison:

For 1:1 Vestibular Rehabilitation Therapy, email madison@thevertigodoctor.com

Otherwise, I’ll see ya in Vestibular Group Fit!

Connect with Dr. Jenna (@dizzy.rehab.therapist): https://www.instagram.com/dizzy.rehab.therapist/

Learn about the Oak Method: http://thevertigodoctor.com/why-vestibular-group-fit

Love what you heard?
Consider leaving a review on your favorite podcast platform to help us reach more vestibular warriors like you!

This podcast is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here.

Citations

“Mountain Vacation? 5 Tips to Cope with Your Altitude Sickness.” Cleveland Clinic, health.clevelandclinic.org/understanding-altitude-sickness-5-best-tips-for-your-next-mountain-trip.

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vertigo and altitude changes, altitude and vertigo, travel and vestibular disorders, vestibular group fit, VGF, living with vestibular disorder, weather & vestibular disorder, change in pressure, inner ear, manage migraine, weatherx earplanes, meniere’s disease, nervous system regulation, chronic dizziness, PPPD

If you’ve ever tried to do too much, crashed hard, and then felt like you were back at square one—this episode is for you. I’m talking about two of the most important concepts we teach in Vestibular Group Fit: scaling and pacing.

It cannot be stressed enough how important this is and how much we talk about it in VGF.

Scaling and pacing aren’t about doing less forever. They’re about building capacity strategically so you can eventually do MORE without paying for it for days afterward.

I’m walking you through real-life examples of how to scale movement, exercise routines, walking, driving, and other daily activities — plus what to do on higher symptom days and post-attack so you can recover faster and get back to living your life.

In this episode, we’ll dig into:

What scaling and pacing actually mean and how they’re different

Why you should never increase more than 10% at a time

How to scale things like strength training, walking, and driving

The difference between “immediate” responders and “hangover” responders

Real-life pacing strategies you can add into your day-to-day life

How to scale down on post-attack or high symptom days

The 30-day to 30-minute return to walk program results from VGF

Summer consistency challenge details for Vestibular Group Fit members

Whether it’s exercise, grocery shopping, driving, or attending your nephew’s graduation—the same principles apply. Scaling and pacing are skills. As with any skill, it takes time, practice, and a whole lot of grace and patience with yourself.

Links Mentioned:

Vestibular Group Fit (code GROUNDED at checkout for 15% off!): https://thevertigodoctor.com/vestibular-group-fit

Inside VGF, we have two helpful lessons: Visualization exercises for return to driving, and a 30-day to 30-minute return to walk program

Free Resources:

⁠The 4 Steps to Managing Vestibular Migraine: https://thevertigodoctor.myflodesk.com/cb5js0y78n

⁠The PPPD Management Masterclass⁠: https://thevertigodoctor.myflodesk.com/new-pppd

⁠What your Partner Should Know About Living with Dizziness⁠: https://thevertigodoctor.myflodesk.com/partnership

⁠The FREE Mini VGFit Workout⁠: https://thevertigodoctor.myflodesk.com/minifit

⁠The FREE POTS – safe Workouts⁠: https://thevertigodoctor.myflodesk.com/pots

Connect with Dr. Madison (@TheVertigoDoctor): https://instagram.com/thevertigodoctor

Work with Dr. Madison:

For 1:1 Vestibular Rehabilitation Therapy, email madison@thevertigodoctor.com

Otherwise, I’ll see ya in Vestibular Group Fit!

Connect with Dr. Jenna (@dizzy.rehab.therapist): https://www.instagram.com/dizzy.rehab.therapist/

Learn about the Oak Method: http://thevertigodoctor.com/why-vestibular-group-fit

Love what you heard?
Consider leaving a review on your favorite podcast platform to help us reach more vestibular warriors like you!

This podcast is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here.

physical activity intensity, scaling and pacing, activity pacing, scaling physical activity, vestibular disorder management, chronic dizziness, living with vestibular disorder, migraine attacks, nervous system regulation, exercises to improve balance, return to walking, driving with vestibular disorder, vestibular exercises