Static and dynamic visual vertical perception in subjects with migraine and vestibular migraine

Mark A. Miller, Benjamin T. Crane

To measure the static visual vertical and the effect of visual rotation on the perception of visual vertical in migraine and vestibular migraine subjects. By so doing, we may better understand the vestibular contribution to the pathophysiology of migraine, as well as the capacity for visual compensation. The perception of visual vertical in the presence of static and dynamic visual cues was prospectively studied in 10 subjects with migraine, 6 subjects with vestibular migraines, and 10 controls. Subjects used a dial to rotate a fluorescent green line to the vertical position. Static visual vertical (SVV) was measured with a black background, as well as with a static random-dot visual pattern. This pattern was then rotated at various velocities to measure dynamic visual vertical (DVV). Migraine subjects had greater deviation from true vertical than controls in SVV (P < 0.05). The DVV in migraine subjects was greater than controls when rotated in the counterclockwise at -5°/s (P < 0.01), -20°/s (P < 0.01), and -80°/s (P < 0.01), but not when the line was rotated clockwise. Vestibular migraine subjects did not deviate significantly from controls in SVV (P < 0.37, P < 0.22), but did show greater deviation in the DVV tasks at -80 and -20°/s (P < 0.05, P < 0.03). Migraine and vestibular migraine subjects demonstrated a wider range of vertical deviance when compared to controls (P < 0.02). This study demonstrates a significant deviation of the perceived static as well as dynamic visual vertical in migraine subjects. Moving stimuli may have a greater influence on migraine and vestibular migraine subjects, which suggests an underlying sensory integration disorder.