ICU – “I SEE YOU” PODCAST
Blood Glucose & Vestibular Migraine
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On this episode of the ICU Podcast, we explore the emerging—and deeply relatable—connection between blood glucose regulation and vestibular migraine, a topic gaining attention across migraine, neurology, and nutrition research. Joining us are Dr. Kyle Bills, co-author of a recent paper examining glucose dynamics in vestibular migraine, and Rachel Weaver, author of Dizzy: A Memoir, who brings her lived experience perspective to the conversation. Together, we unpack how brain energy metabolism, insulin sensitivity, genetic links to glycemic traits, and everyday factors like diet and lifestyle may influence migraine biology—especially for people whose symptoms include dizziness and balance disruption. This discussion bridges cutting-edge science with real-world insight, offering listeners a clearer understanding of why blood sugar stability may matter in vestibular migraine and how this knowledge could shape more personalized management strategies.
Guests
Rachel Weaver’s novel Point of Direction was named a Top Ten Book To Pick Up Now by Oprah Magazine and won the Willa Cather Award for Fiction. Rachel’s newest book, Dizzy, an “arresting new memoir” according to Maureen Corrigan on NPR’s Fresh Air, published in February of 2026. Her second novel The Last Run, is forthcoming in June 2026 with Lake Union Publishing. Prior to earning her MFA in Writing and Poetics at Naropa University, Rachel worked for the Forest Service in Alaska studying bears, raptors and songbirds. She teaches at Wilkes University and Lighthouse Writers Workshop and holds a CPA in Narrative Medicine from Columbia University. For twenty years, Rachel has lived with vestibular migraine. For more information visit her website here.
Dr. Kyle Bills is a neurologist and headache specialist with a clinical and research interest in vestibular migraine and the role of metabolism in migraine disorders. He is a co-author of a recent study examining glucose dynamics in vestibular migraine, contributing to a growing body of research exploring how blood sugar regulation, brain energy metabolism, and lifestyle factors may influence migraine symptoms. Through his work, Dr. Bills seeks to better understand the biological mechanisms underlying vestibular migraine and how this knowledge can improve diagnosis, treatment, and quality of life for patients living with dizziness and migraine. You can find Dr. Bill’s most recent paper on Glucose dysregulation and glycemic phenotyping in chronic migraine here.
When Blood Sugar and Vestibular Migraine Collide: A New Way of Seeing Symptoms
On a perfectly ordinary morning almost twenty years ago, Rachel Weaver opened her eyes and discovered that the world would not hold still.
The dizziness hit out of nowhere. Not a brief spell, not a few shaky seconds. It was constant, all-consuming, and it never stopped. For the next 18 years, Rachel lived as if the ground beneath her were always tilting — through pregnancies, book deadlines, parenting twin boys, and the daily work of trying to move through a life that felt permanently unsteady.
Doctors took her seriously. They ordered MRIs and bloodwork, ruled out tumors and MS, checked everything they knew how to check. On paper, she looked fine. Inside her body, she was anything but.
Like many people with vestibular migraine, Rachel’s journey became a long, exhausting loop of specialists, medications, and partial answers. Eventually she was given the label vestibular migraine, even though she rarely had a classic pounding headache. Her main symptom was relentless dizziness. Some migraine medications and interventions helped “take the edge off,” but they never gave her back a steady baseline. She still woke up dizzy. She still went to bed dizzy.
And through it all, there was the subtle, gnawing question: What am I missing?
Clues in the Kitchen
Friends and providers suggested what they often suggest: maybe it’s gluten. Maybe it’s dairy. Maybe it’s caffeine, or chocolate, or aged cheese. Rachel, like so many patients eager to get their life back, tried it all.
Nothing really changed.
Over time, though, she began to notice small patterns. If she went too long without eating, her dizziness seemed to intensify. Sometimes, when she finally ate, she felt a little better. Other times, food made things worse. There was clearly some relationship between what she ate and how she felt, but it was messy and inconsistent — one more puzzle layered on top of the mystery.
She committed herself to the “Heal Your Headache” diet for nearly a year. It helped, but only partially. The dizziness remained a constant companion. She still couldn’t identify a clean, predictable trigger. Her life felt like an endless experiment with no clear results.
That’s the emotional terrain she was standing on when she eventually stumbled—via a Google search—onto the work of Dr. Kyle Bills, a neurologist and headache specialist who was asking a different set of questions about migraine.
A Doctor Who Asked About Blood Sugar
By the time Rachel scheduled an appointment with Dr. Bills, she was burned out on hope. Every new provider meant telling her story again, revisiting disappointment, and bracing for the possibility that nothing would change.
But from their first conversation, something felt different.
Instead of focusing narrowly on classic food “triggers,” Dr. Bills began asking detailed questions about timing, meals, energy levels, crashes, and patterns around eating. He wanted to know not just what she ate, but what happened after she ate. How quickly did she feel worse or better? Did she ever feel shaky, panicky, exhausted out of proportion to her day?
As he spoke, describing a particular pattern of blood sugar instability, Rachel felt a shock of recognition. She remembers sitting in the car with her husband during that first call and saying:
“I feel like he’s known me my whole life.”
Her husband, understandably, asked, “Who are you talking to?”
“Some new doctor,” she answered. But internally, something was shifting. The questions he asked, the way he connected dots she had sensed but couldn’t name — it all made unnerving sense.
And yet, she was scared. The protocol he proposed — a strict, therapeutic ketogenic diet paired with close monitoring of her glucose — sounded incredibly demanding. She was already exhausted. She didn’t know if she had the strength to try something that might not work.
Hope, at that point, felt dangerous.
The Science Behind the Story
While Rachel weighed whether to take this leap, Dr. Bills was coming at the problem from a different angle: decades of migraine research and a growing suspicion that traditional ways of classifying migraine were missing something important.
For years, studies have suggested that glucose — the brain’s primary fuel — behaves differently during migraine attacks. The problem is, the data have often been confusing and contradictory. Some research finds clear changes in glucose; other studies don’t. Some suggest blood sugar is relevant; others seem to rule it out.
Part of the problem, Dr. Bills explains, is how we sort people into diagnostic buckets. Migraine, and especially vestibular migraine, is usually defined by symptoms: dizziness, aura, pain, frequency, sensitivity to light or sound. That makes sense clinically — patients experience symptoms — but it doesn’t tell us how they arrived at those symptoms biologically.
He uses the idea of phenotypes to explain this. Two people can both be labeled with vestibular migraine, but the road that led them there may be completely different:
- One person might be dealing with structural nerve issues.
- Another might have a subtle metabolic problem, like reactive hypoglycemia and altered insulin sensitivity.
On paper, they look the same. Inside their bodies, they are not.
To explore these hidden differences, Dr. Bills and his team began doing more in-depth metabolic testing:
- Glucose tolerance tests that tracked both glucose and insulin over several hours.
- Continuous glucose monitoring, recording blood sugar every few minutes in everyday life.
What they saw was eye-opening. Standard tests like fasting blood sugar or A1C were often normal, even in patients whose bodies were clearly struggling with glucose. But longer testing revealed a different story for a subset of people:
- Blood sugar would spike quickly after a meal, then plunge below baseline — a pattern known as reactive hypoglycemia.
- These rapid swings were accompanied by intense emotional and physical symptoms:
- A sense of panic or “impending doom” when sugar shot up.
- Crushing fatigue and low mood when it crashed.
From a neuroscience perspective, those fast rises and falls in glucose can set the stage for excessive, errant nerve firing in the brain — including phenomena like cortical spreading depression, which can leave people feeling foggy, hungover, and destabilized.
By analyzing enough of this continuous data, the team began to see clusters emerge:
- Some patients with vestibular migraine had no meaningful glucose dysregulation.
- Others had clear, reproducible patterns of metabolic instability that correlated with their symptoms.
They all shared the same diagnosis, but their biological phenotypes were very different.
“Waking Back Up Inside Your Own Life”
Rachel decided to try.
With support from Dr. Bills’ clinic, she began a therapeutic ketogenic diet, carefully structured to stabilize her blood sugar and calm that constant metabolic turbulence. They monitored her, adjusted, and guided her through the early days.
Within 24 to 48 hours, something shifted. Her mind felt clearer than it had in years. Then came the “keto flu” — a rough, temporary phase the clinic had warned her about — but it passed. Within about a week, she describes feeling as if she had “woken back up inside [her] own body and inside [her] own life.”
Her family noticed instantly. Her teenage sons and husband watched this suddenly animated, energetic woman move through the house, eager to do things, to engage, to talk. The contrast to the diminished, careful version of her they had known for years was almost disorienting.
She remembers being on a bumpy dirt road during a camping trip, waiting for the familiar wave of nausea and disorientation. It never came. She turned to her kids, almost in disbelief: “We’re on a bumpy road right now, and I don’t feel like I’m going to puke.”
That might not sound like a miracle to someone who has never lived in a spinning world. To Rachel, it was astonishing.
Today, her life is not symptom-free. She still has occasional dizzy days, especially with stress, poor sleep, or big weather changes. But instead of being dizzy every hour of every day, she now has months punctuated by a few rough days. And instead of relying on an arsenal of prescription medications, she can usually manage flares with something as simple as ibuprofen — because the underlying instability has quieted.
She eats low carb as a long-term lifestyle, with a bit more flexibility than in the early protocol. When she steals a few bites of her kids’ ice cream, the dizziness hums back briefly, then fades. That clear, immediate feedback loop has become its own motivation. As she puts it, “I don’t care if I ever touch a carb again.”
More Than a Cure: Collaboration and Acceptance
If this were only a story about diet, it would be incomplete.
Throughout the conversation, both Rachel and Dr. Bills circle back to two deeper themes: collaboration and acceptance.
For Dr. Bills, the kind of careful, phenotype-driven research he does is only possible when patients are true partners— honest about what’s working and what isn’t, willing to push back, to say, “That’s not what my body is doing.” He talks about the need for humility on all sides: doctors grounded in data but open to being wrong, and patients who bring not just symptoms, but insight.
For Rachel, the turning point was not only biochemical; it was also emotional. Looking back, she can finally feel compassion for the version of herself who kept showing up for appointments, kept trying, kept getting hurt by disappointment. She urges others to allow themselves:
- Periods of rest from the search for a cure.
- Moments of acceptance for the body they have right now, even while staying open to new possibilities.
Because sometimes, she reminds us, you can remove the biggest burden — the dizziness, the pain — and still find that the experience has changed your brain, your relationships, your view of the world. Healing becomes as much about reclaiming your life as it is about calming your nervous system.
For a subset of people with vestibular migraine, blood glucose may be one crucial piece of that calming. For others, it may not be the central driver at all. But hearing Rachel’s story alongside Dr. Bills’ research offers something rare in chronic illness: a new, concrete avenue to explore — and a reminder that even after years of spinning, it might still be possible to wake back up inside your own life.
