The Value of Subjective Visual Vertical in Diagnosis of Vestibular Migraine

Abstract

Objective To study the value of the subjective visual vertical (SVV) in the diagnosis of vestibular migraine (VM). Methods This study recruited 128 VM patients and 64 age-matched normal subjects. We detected the SVV during the interval between attacks in both groups, in sitting upright, and the head tilted at 45° to the left or right. We then examined the correlation between the SVV results with the vestibular evoked myogenic potential (VEMP) and canal paresis (CP). Results It was found there was a significant difference in SVV at the upright position between VM patients and normal controls (P=0.006) and no significant difference was found at the tilts of 45° to the left or right between the two groups. The SVV results at the upright position were significantly correlated with cervical VEMP (P=0.042) whereas not significantly correlated with CP and VEMP. There existed no significant difference in the conformity to the Müller effect (M effect) between the two groups. ROC analysis exhibited that the sensitivity, specificity of SVVs at the upright were 67.200% and 62.500% respectively. The diagnostic value of SVV at the upright position was significantly higher than that at tilts of 45° to the left and right (P=0.006). Nonetheless the diagnostic accuracy was relatively low. Conclusion Abnormality in SVV possibly stems from the lasting functional disorder of cerebellar or high-level cortical centers in VM patients or is linked to the vestibular compensation. The SVV is of low diagnostic value for VM and the value of SVV in VM warrants further study.

A Cross-Sectional Study on the Effect of Chronic Noise Exposure on the Vestibular Function of Traffic Policemen and Automobile Drivers

“…It is commonly used to assess the otolith system particularly the utricle and can be a reliable marker of the degree of vestibular compensation after an acute vestibular deafferentiation. [ 19 20 ] There was no correlation of the SVV with VEMP latency and amplitude as was also seen in study by Mueller et al . [ 21 ] This is possible as both these tests measure different types of hair cell functions in the utricular macula.…”

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

“…To evaluate our question, additional work using previous classification systems was included for review, with the understanding that there are likely differences in patient identification. Previous studies evaluating static SVV performance in those with migraine and dizziness have found both appropriate 21 22 23 and inappropriate 24 25 mean tilt values with the head in the upright position. Specifically, Asai and colleagues 25 describe small cohort of patients with migraine, tension headache, and no headache, finding that those meeting criteria for migraine and tension headache demonstrated significantly greater mean SVV tilt than nonheadache patients.…”

“…Crevits et al 23 ) and inappropriate (Li et al 24 ; Asai et al 25 ) mean tilt values with the head in the upright position. Specifically, Asai and colleagues 25 describe small cohort of patients with migraine, tension headache, and no headache, finding that those meeting criteria for migraine and tension headache demonstrated significantly greater mean SVV tilt than non-headache patients.…”

“…Winnick and colleagues 21 reported on 27 patients with VM along with 27 healthy controls, noting no significant differences in SVV performance in terms of accuracy or precision with the head upright. Conversely, Li and colleagues 24 found that 37% of their patients with VM (n ¼ 47/128) demonstrated atypical SVV mean tilt and wider range of overall performance. A recent meta-analysis suggests abnormal mean SVV tilt is likely present in those with primary headache disorders, including migraine and tension-type headache.…”