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J Am Acad Audiol 2022; 33(07/08): 396-404
DOI: 10.1055/a-1938-1161
Research Article

Static Subjective Visual Vertical (SVV) in Patients with Vestibular Migraine

Jamie M. Bogle
1   Department of Otorhinolaryngology, Mayo Clinic Arizona, Scottsdale, Arizona
,
Ashley Zaleski King
2   Department of Speech-Language/Audiology, Towson University, Towson, Maryland
,
Nicholas Deep
1   Department of Otorhinolaryngology, Mayo Clinic Arizona, Scottsdale, Arizona
,
Peter Weisskopf
1   Department of Otorhinolaryngology, Mayo Clinic Arizona, Scottsdale, Arizona
,
Amaal J. Starling
3   Department of Neurology, Mayo Clinic Arizona, Phoenix, Arizona
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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

Note

Portions of this manuscript were presented at the annual meeting of the American Balance Society, March 2, 2021.




Publication History

Received: 18 February 2022

Accepted: 30 August 2022

Accepted Manuscript online:
07 September 2022

Article published online:
22 February 2023

© 2023. American Academy of Audiology. This article is published by Thieme.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Neuhauser HK, Radtke A, von Brevern M. et al. Migrainous vertigo: prevalence and impact on quality of life. Neurology 2006; 67 (06) 1028-1033
    CrossrefPubMedSearch in Google Scholar
  • 2 Formeister EJ, Rizk HG, Kohn MA, Sharon JD. The epidemiology of vestibular migraine: a population-based survey study. Otol Neurotol 2018; 39 (08) 1037-1044
    CrossrefPubMedSearch in Google Scholar
  • 3 Cho SJ, Kim BK, Kim BS. et al. Vestibular migraine in multicenter neurology clinics according to the appendix criteria in the third beta edition of the International Classification of Headache Disorders. Cephalalgia 2016; 36 (05) 454-462
    CrossrefPubMedSearch in Google Scholar
  • 4 Yollu U, Uluduz DU, Yilmaz M. et al. Vestibular migraine screening in a migraine-diagnosed patient population, and assessment of vestibulocochlear function. Clin Otolaryngol 2017; 42 (02) 225-233
    CrossrefPubMedSearch in Google Scholar
  • 5 Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018. 38. (1): 1-211
    Search in Google Scholar
  • 6 Beh SC, Masrour S, Smith SV, Friedman DI. The spectrum of vestibular migraine: clinical features, triggers, and examination findings. Headache 2019; 59 (05) 727-740
    CrossrefPubMedSearch in Google Scholar
  • 7 Zhang Y, Kong Q, Chen J, Li L, Wang D, Zhou J. International classification of headache disorders 3rd edition beta-based field testing of vestibular migraine in China: demographic, clinical characteristics, audiometric findings and diagnosis statues. Cephalalgia 2016; 36 (03) 240-248
    CrossrefPubMedSearch in Google Scholar
  • 8 Dieterich M, Obermann M, Celebisoy N. Vestibular migraine: the most frequent entity of episodic vertigo. J Neurol 2016; 263 (Suppl 1): S82-S89
    CrossrefPubMedSearch in Google Scholar
  • 9 Kırkım G, Mutlu B, Olgun Y. et al. Comparison of audiological findings in patients with vestibular migraine and migraine. Turk Arch Otorhinolaryngol 2017; 55 (04) 158-161
    CrossrefPubMedSearch in Google Scholar
  • 10 Neff BA, Staab JP, Eggers SD. et al. Auditory and vestibular symptoms and chronic subjective dizziness in patients with Ménière's disease, vestibular migraine, and Ménière's disease with concomitant vestibular migraine. Otol Neurotol 2012; 33 (07) 1235-1244
    CrossrefPubMedSearch in Google Scholar
  • 11 Espinosa-Sanchez JM, Lopéz-Escamez JA. New insights into pathophysiology of vestibular migraine. Front Neurol 2015; 6: 12
    CrossrefPubMedSearch in Google Scholar
  • 12 Boldingh MI, Ljøstad U, Mygland A, Monstad P. Vestibular sensitivity in vestibular migraine: VEMPs and motion sickness susceptibility. Cephalalgia 2011; 31 (11) 1211-1219
    CrossrefPubMedSearch in Google Scholar
  • 13 Lewis RF, Priesol AJ, Nicoucar K, Lim K, Merfeld DM. Abnormal motion perception in vestibular migraine. Laryngoscope 2011; 121 (05) 1124-1125
    CrossrefPubMedSearch in Google Scholar
  • 14 Salviz M, Yuce T, Acar H, Taylan I, Yuceant GA, Karatas A. Diagnostic value of vestibular-evoked myogenic potentials in Ménière's disease and vestibular migraine. J Vestib Res 2016; 25 (5-6): 261-266
    CrossrefPubMedSearch in Google Scholar
  • 15 Zuniga MG, Janky KL, Schubert MC, Carey JP. Can vestibular-evoked myogenic potentials help differentiate Ménière disease from vestibular migraine?. Otolaryngol Head Neck Surg 2012; 146 (05) 788-796
    CrossrefPubMedSearch in Google Scholar
  • 16 Zaleski-King A, Pinto R, Tamaki C, Bogle J, McCaslin D, Brungart D. Oculomotor and perceptual measures of visual motion sensitivity in patients with chronic dizziness symptoms. Ear Hear 2022; 43 (05) 1515-1525
    CrossrefPubMedSearch in Google Scholar
  • 17 Wang J, Lewis RF. Contribution of intravestibular sensory conflict to motion sickness and dizziness in migraine disorders. J Neurophysiol 2016; 116 (04) 1586-1591
    CrossrefPubMedSearch in Google Scholar
  • 18 Kheradmand A, Winnick A. Perception of upright: multisensory convergence and the role of the temporo-parietal cortex. Front Neurol 2017; 8: 552
    CrossrefPubMedSearch in Google Scholar
  • 19 Barra J, Marquer A, Joassin R. et al. Humans use internal models to construct and update a sense of verticality. Brain 2010; 133 (Pt 12): 3552-3563
    CrossrefPubMedSearch in Google Scholar
  • 20 De Vrijer M, Medendorp WP, Van Gisbergen JAM. Accuracy-precision trade-off in visual orientation constancy. J Vis 2009; 9 (02) 9.1-15
    CrossrefPubMedSearch in Google Scholar
  • 21 Winnick A, Sadeghpour S, Otero-Millan J, Chang TP, Kheradmand A. Errors of upright perception in patients with vestibular migraine. Front Neurol 2018; 9: 892
    CrossrefPubMedSearch in Google Scholar
  • 22 Best C, Eckhardt-Henn A, Diener G, Bense S, Breuer P, Dieterich M. Interaction of somatoform and vestibular disorders. J Neurol Neurosurg Psychiatry 2006; 77 (05) 658-664
    CrossrefPubMedSearch in Google Scholar
  • 23 Crevits L, Vanacker L, Verraes A. Patients with migraine correctly estimate the visual verticality. Clin Neurol Neurosurg 2012; 114 (04) 313-315
    CrossrefPubMedSearch in Google Scholar
  • 24 Li F, Xu J, Li GR. et al. The value of subjective visual vertical in diagnosis of vestibular migraine. Curr Med Sci 2021; 41 (04) 654-660
    CrossrefPubMedSearch in Google Scholar
  • 25 Asai M, Aoki M, Hayashi H, Yamada N, Mizuta K, Ito Y. Subclinical deviation of the subjective visual vertical in patients affected by a primary headache. Acta Otolaryngol 2009; 129 (01) 30-35
    CrossrefPubMedSearch in Google Scholar
  • 26 Kandemir A, Çelebisoy N, Köse T. Perception of verticality in patients with primary headache disorders. J Int Adv Otol 2014; 10 (02) 138
    CrossrefSearch in Google Scholar
  • 27 Obrero-Gaitán E, Manrique-Navarro M, Lérida-Ortega MA, Rodríguez-Almagro D, Osuna-Pérez MC, Lomas-Vega R. Misperception of visual verticality in patients with primary headache disorders: a systematic review with meta-analysis. Brain Sci 2020; 10 (10) 664
    CrossrefPubMedSearch in Google Scholar
  • 28 Jacobson GP, Newman CW. The development of the dizziness handicap inventory. Arch Otolaryngol Head Neck Surg 1990; 116 (04) 424-427
    CrossrefPubMedSearch in Google Scholar
  • 29 Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006; 166 (10) 1092-1097
    CrossrefPubMedSearch in Google Scholar
  • 30 Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001; 16 (09) 606-613
    CrossrefPubMedSearch in Google Scholar
  • 31 Stewart WF, Lipton RB, Dowson AJ, Sawyer J. Development and testing of the Migraine Disability Assessment (MIDAS) Questionnaire to assess headache-related disability. Neurology 2001; 56 (06) , Suppl 1): S20-S28
    CrossrefPubMedSearch in Google Scholar
  • 32 Miller MA, Crane BT. Static and dynamic visual vertical perception in subjects with migraine and vestibular migraine. World J Otorhinolaryngol Head Neck Surg 2016; 2 (03) 175-180
    CrossrefPubMedSearch in Google Scholar
  • 33 Ashish G, Augustine AM, Tyagi AK, Lepcha A, Balraj A. Subjective visual vertical and horizontal in vestibular migraine. J Int Adv Otol 2017; 13 (02) 254-258
    CrossrefPubMedSearch in Google Scholar
  • 34 Previc FH. Intravestibular balance and motion sickness. Aerosp Med Hum Perform 2018; 89 (02) 130-140
    CrossrefPubMedSearch in Google Scholar
  • 35 King S, Priesol AJ, Davidi SE, Merfeld DM, Ehtemam F, Lewis RF. Self-motion perception is sensitized in vestibular migraine: pathophysiologic and clinical implications. Sci Rep 2019; 9 (01) 14323
    CrossrefPubMedSearch in Google Scholar
  • 36 Yakushin SB, Bukharina SE, Raphan T, Buttner-Ennever J, Cohen B. Adaptive changes in the angular VOR: duration of gain changes and lack of effect of nodulo-uvulectomy. Ann N Y Acad Sci 2003; 1004: 78-93
    CrossrefPubMedSearch in Google Scholar
  • 37 Angelaki DE, Hess BJ. The cerebellar nodulus and ventral uvula control the torsional vestibulo-ocular reflex. J Neurophysiol 1994; 72 (03) 1443-1447
    CrossrefPubMedSearch in Google Scholar
  • 38 Angelaki DE, Hess BJ. Lesion of the nodulus and ventral uvula abolish steady-state off-vertical axis otolith response. J Neurophysiol 1995; 73 (04) 1716-1720
    CrossrefPubMedSearch in Google Scholar
  • 39 Kim HA, Lee H, Yi HA, Lee SR, Lee SY, Baloh RW. Pattern of otolith dysfunction in posterior inferior cerebellar artery territory cerebellar infarction. J Neurol Sci 2009; 280 (1–2): 65-70
    CrossrefPubMedSearch in Google Scholar
  • 40 Kitama T, Komagata J, Ozawa K, Suzuki Y, Sato Y. Plane-specific Purkinje cell responses to vertical head rotations in the cat cerebellar nodulus and uvula. J Neurophysiol 2014; 112 (03) 644-659
    CrossrefPubMedSearch in Google Scholar
  • 41 Walker MF, Tian J, Shan X, Tamargo RJ, Ying H, Zee DS. Lesions of the cerebellar nodulus and uvula in monkeys: effect on otolith-ocular reflexes. Prog Brain Res 2008; 171: 167-172
    CrossrefPubMedSearch in Google Scholar
  • 42 Cohen H, Cohen B, Raphan T, Waespe W. Habituation and adaptation of the vestibuloocular reflex: a model of differential control by the vestibulocerebellum. Exp Brain Res 1992; 90 (03) 526-538
    CrossrefPubMedSearch in Google Scholar
  • 43 Dai M, Kunin M, Raphan T, Cohen B. The relation of motion sickness to the spatial-temporal properties of velocity storage. Exp Brain Res 2003; 151 (02) 173-189
    CrossrefPubMedSearch in Google Scholar
  • 44 Schuerger RJ, Balaban CD. Organization of the coeruleo-vestibular pathway in rats, rabbits, and monkeys. Brain Res Brain Res Rev 1999; 30 (02) 189-217
    CrossrefPubMedSearch in Google Scholar
  • 45 Buisseret-Delmas C, Compoint C, Delfini C, Buisseret P. Organisation of reciprocal connections between trigeminal and vestibular nuclei in the rat. J Comp Neurol 1999; 409 (01) 153-168
    CrossrefPubMedSearch in Google Scholar
  • 46 Venhovens J, Meulstee J, Verhagen WIM. Static subjective visual vertical in healthy volunteers: the effects of different preset angle deviations and test-retest variability. Neuroophthalmology 2016; 40 (03) 113-119
    CrossrefPubMedSearch in Google Scholar