Subjective Visual Vertical and Horizontal in Vestibular Migraine

Ashish, Gaurav; Augustine, Ann Mary; Tyagi, Amit Kumar; Lepcha, Anjali; Balraj, Achamma

doi:10.5152/iao.2017.4056

Cited by 26 publications

(39 citation statements)

References 22 publications

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“…Those reports showed no significant deviations, or only very subtle, non-pathological deviations. Two recent studies have shown that patients with vestibular migraine have SVV similar with normal controls, as we report [34,35]. Similar with prior data, rarely did we find that VM can cause an abnormal SVV deviation (2/36; 5.6%) during an acute episode.…”

Section: Discussionsupporting

confidence: 92%

The Bucket Test Differentiates Patients with MRI Confirmed Brainstem/Cerebellar Lesions from Patients Having Migraine and Dizziness Alone

Chang¹,

Winnick

Hsu

et al. 2019

Preprint

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Background: Amongst the most challenging diagnostic dilemmas managing patients with vestibular symptoms (i.e. vertigo, nausea, imbalance) is differentiating dangerous central vestibular disorders from benign causes. Migraine has long been recognized as one of the most common causes of vestibular symptoms, but the clinical hallmarks of vestibular migraine are notoriously inconsistent and thus the diagnosis is difficult to confirm. Here we conducted a prospective study investigating the sensitivity and specificity of combining standard vestibular and neurological examinations to determine how well central vestibular disorders (CVD) were distinguishable from vestibular migraine (VM). Method: Thirty symptomatic patients diagnosed with CVD and 36 symptomatic patients with VM underwent brain imaging and clinical assessments including; 1) SVV bucket test, 2) ABCD2, 3) headache/vertigo history, 4) presence of focal neurological signs, 5) nystagmus, and 6) clinical head impulse testing. Results: Mean absolute SVV deviations measured by bucket testing in CVD and VM were 4.8±4.0° and 0.7±1.0°, respectively. The abnormal rate of SVV deviations (>2.3°) in CVD was significantly higher than VM (p<0.001). Using the bucket test alone to differentiate CVD from VM, sensitivity was 73.3%, specificity 91.7%, positive likelihood ratio (LR+) 8.8, and negative likelihood ratio (LR-) 0.3. However, when we combined the SVV results with the clinical exam assessing gaze stability (nystagmus) with an abnormal focal neurological exam, the sensitivity (93.3%) and specificity (88.9%) were optimized (LR+ (8.4), LR- (0.08)). Conclusion: The SVV bucket test is a useful clinical test to distinguish CVD from VM, particularly when interpreted along with the results of a focal neurological exam and clinical exam for nystagmus.

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Section: Discussionsupporting

confidence: 92%

The Bucket Test Differentiates Patients with MRI Confirmed Brainstem/Cerebellar Lesions from Patients Having Migraine and Dizziness Alone

Chang¹,

Winnick

Hsu

et al. 2019

Preprint

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“…It seems that vestibular symptoms come from the vestibular nuclei, which are simultaneously suppressed by inhibitory feedback from the cerebellar nodulus and uvula [33]. There is also evidence of otolithic pathway abnormalities in individuals with VM [34]. It is also suggested that Purkinje cells in the paraflocculus could be inhibited after the occurrence of a migraine episode, which may be an important factor leading to vestibular migraine [35].…”

Section: Pathophysiology Of Vmmentioning

confidence: 99%

Vestibular migraine — an underdiagnosed cause of vertigo. Diagnosis and treatment

Nowaczewska

2020

Neurol Neurochir Pol.

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Introduction. Migraine and vertigo are two common conditions. The main disorder connecting both these entities is vestibular migraine (VM). State of the art. VM may affect 1-3% of the general population. It is a disabling disease of recurrent attacks of vestibular symptoms accompanied by migraine features which occur in patients with a current or previous history of migraine. The episodes can last minutes, hours or even days, and may occur without any concurrent headache, which can prompt misdiagnosis. VM often begins several years after a typical migraine, and the delay between onset of headache and vertigo may be long. The diagnosis is based on the patient's clinical history and can be challenging due to the lack of an established confirmatory diagnostic test or biomarkers. The mechanism of vestibular migraine remains unclear and is still under investigation, but it seems to be an interaction between trigeminal and vestibular systems. Due to the lack of specific trials, treatment recommendations are based on migraine guidelines. Several drugs seem to be effective, although there have been few randomised controlled trials in this area. Regardless of the published strict and detailed diagnostic criteria, this condition remains little known, and as a consequence is underdiagnosed and undertreated. Clinical implications. Efforts should be made to educate medical communities and patients about this disease and to encourage neurologists and ENT specialists to cooperate. Every patient with vertigo of unknown origin should be directly asked about a past or present history of migraine, or migraine symptoms experienced during their vertigo episodes. Future directions. There is a growing need for studies regarding the pathophysiology of VM as well as randomised trials to establish clear treatment recommendations and to improve management of this surprisingly common disorder.

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“…Figure 2 shows the number of records removed and the reasons for exclusion. Finally, seven studies [ 52 , 53 , 54 , 55 , 56 , 57 , 58 ] were included in the present review.…”

Section: Resultsmentioning

confidence: 99%

“…The seven studies included in this review comprised 10 samples with 10 independent comparisons providing data from 816 participants (34% males and 66% females). The seven studies [ 52 , 53 , 54 , 55 , 56 , 57 , 58 ] had eight independent comparisons, including 669 patients with migraine (mean age of 36.72 ± 4.9 years old); two of the studies [ 52 , 56 ] had two independent comparisons with reported data for 147 subjects with TTH (mean age of 39.52 ± 6.81 years old). The exposed group incorporated patients with migraine and TTH, and 364 healthy subjects formed the non-exposed group (mean age 35.87 ± 5.81 years old).…”

Section: Resultsmentioning

confidence: 99%

Misperception of Visual Verticality in Patients with Primary Headache Disorders: A Systematic Review with Meta-Analysis

et al. 2020

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Migraine and tension-type headache (TTH) are the two most prevalent primary headache disorders (PHDs) that may involve visual and vestibular impairments, neck pain, and postural unsteadiness. The perception of visual verticality (VV) has been studied in patients diagnosed with PHD to assess balance disorders showing varying findings. Our study aimed to assess the VV perception in patients diagnosed with PHD in comparison to healthy controls. A systematic review with meta-analysis was carried out in PubMed MEDLINE, Scopus, WOS, CINAHL, and SciELO. The Cohen standardized mean difference (SMD) was used to estimate the differences between exposed and healthy controls. Seven studies with 816 participants were included. The quality of included studies, according to the Newcastle–Ottawa Scale (NOS), was moderate (mean score of 5.2). Patients diagnosed with PHD showed a moderate misperception of VV as assessed with the subjective visual vertical (SVV) test (SMD = 0.530; 95% CI = 0.225, 0.836; p < 0.001). Specifically, a misperception of the SVV was found in patients with migraine (SMD = 0.369; 95% CI = 0.1, 0.638; p = 0.007) and with TTH (SMD = 1.122; 95% CI = 0.540, 1.704; p < 0.001). This review shows a misperception of VV in patients with migraine and TTH when assessed with the SVV test, being higher in patients with TTH, although the THH sample size was low.

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Subjective Visual Vertical and Horizontal in Vestibular Migraine

Cited by 26 publications

References 22 publications

The Bucket Test Differentiates Patients with MRI Confirmed Brainstem/Cerebellar Lesions from Patients Having Migraine and Dizziness Alone

The Bucket Test Differentiates Patients with MRI Confirmed Brainstem/Cerebellar Lesions from Patients Having Migraine and Dizziness Alone

Vestibular migraine — an underdiagnosed cause of vertigo. Diagnosis and treatment

Misperception of Visual Verticality in Patients with Primary Headache Disorders: A Systematic Review with Meta-Analysis

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