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

Objective: 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. Methods: 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). Results: 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). Conclusions: A slight SVV tilt persists between vertigo attacks and correlates with migraine imbalance underlying side-prevalent symptoms.