Perception of Verticality in Patients with Primary Headache Disorders

Abstract

OBJECTIVE: Migraine is associated with several vestibular syndromes, and vestibular syndromes can cause tilt of the subjective visual vertical (SVV). MATERIALS and METHODS: Caloric tests, cervical vestibular evoked myogenic potentials (cVEMPs), and SVV deviations were studied in a group, including 20 patients with migraine without aura (MoA), 24 patients with vestibular migraine (VM), 20 patients with tension-type headache (TTH), and 30 healthy controls. SVV deviations were measured using a translucent bucket. The procedure was repeated 10 times, and the mean SVV deviation was calculated for each subject. RESULTS: Apart from 5 patients with VM, the caloric test results were normal. cVEMP latencies, amplitudes, and SVV deviation values measured from the patient groups were not statistically different from the healthy controls. Despite not having differences in the average SVV deviation compared to controls, patients with migraine, either associated with vertigo or not, had significantly larger variability in their SVV measurements when all 10 test trials were taken into consideration. CONCLUSION: The larger variability of SVV measurements in our patients with migraine has also been reported in a previous study. It is difficult to inter pret this finding as evidence of vestibular dysfunction involving the otolithic pathways. Cognitive processes affecting the awareness of body orientation seem to be a more reasonable explanation. On the other hand, the bucket method is an easily performed, reliable bedside test to study SVV.