Side correlation between subjective visual vertical tilt and symptoms in migraine with vertigo

To analyse the subjective visual vertical (SVV) in migraine patients with balance disorders and its correlation with symptoms. We hypothesise that vestibular imbalance reflects a global migraine activation leading to symptom prevalence on one side.

Twenty-six migraine patients with vertigo and/or dizziness (Group A) were studied in the interictal period. Symptoms assessed: unilateral (U) vs bilateral (B) headache (H), cranial autonomic (CAS) or cochlear symptoms (CS), vertigo/dizziness. SVV test was performed in all participants. Group A was compared to Group B (migraine without vertigo/dizziness) and Group C (controls). Main parameters: SVV0 (mean tilt in 6 trials) and SVV side exclusivity (SE: tilt of same sign in ≥ 5 trials).

SVV0A (0.80 ± 0.68) was significantly greater than SVV0B (0.39 ± 0.40; p = 0.01) and SVV0C (0.32 ± 0.19; p = 0.001). SVV SE was found in 78.6% of patients with vertigo and 18.7% with dizziness (p = 0.003). SVV SE incidence was higher in UH (64.7%) vs BH (11.1%; p = 0.02), and in UCAS (72.7%) and UCS (85.7%) vs BCAS/none (26.6%) and BCS/none (31.6%) (p = 0.02; p = 0.04).

A slight SVV tilt persists between vertigo attacks and correlates with migraine imbalance underlying side-prevalent symptoms.