Abstract
Background Vestibular migraine (VM) is one of the common causes of episodic dizziness, but it
is underdiagnosed and poorly understood. Previous research suggests that otolith reflex
pathway performance is often impaired in this patient group, leading to altered perception
of roll plane stimuli. Clinically, this perception can be measured with subjective
visual vertical (SVV) testing.
Purpose The aim of this study is to compare static SVV performance (absolute mean SVV tilt,
variance) in a cohort of patients diagnosed with VM to results obtained from clinically
derived normative data.
Study Design Retrospective case review.
Study Sample Ninety-four consecutive patients between 18 and 65 years of age diagnosed with VM
were included in this comparison to clinically derived normative data.
Data Collection and Analysis Retrospective chart review was completed. Demographic data, symptom report, and vestibular
laboratory results were documented. SVV performance was documented in terms of absolute
mean SVV tilt and response variance.
Results Abnormal mean SVV tilt was described in 54% (n = 51) of patients with VM. Including abnormal response variance increased those identified
with abnormal presentation to 67% (n = 63). Laboratory findings were insignificant for semicircular canal function, but
of those with abnormal ocular vestibular myogenic potential results (n = 30), 77% (n = 23) demonstrated both abnormal SVV and utriculo-ocular reflex performance. There
were no associations noted for SVV performance and demographic or other self-report
variables.
Conclusion Absolute mean SVV tilt and response variance are often abnormal in patients diagnosed
with VM. These findings support theories suggesting atypical intralabyrinthine integration
within the vestibular nuclei and cerebellar nodular pathways.
Keywords
vestibular - migraine - otolith - vertical
