J Am Acad Audiol
DOI: 10.1055/a-1938-1161
Research Article

Static Subjective Visual Vertical (SVV) in Patients with Vestibular Migraine

Jamie M. Bogle
1   Department of Otorhinolaryngology, Mayo Clinic Arizona, Scottsdale, Arizona
Ashley Zaleski King
2   Department of Speech-Language/Audiology, Towson University, Towson, Maryland
Nicholas Deep
1   Department of Otorhinolaryngology, Mayo Clinic Arizona, Scottsdale, Arizona
Peter Weisskopf
1   Department of Otorhinolaryngology, Mayo Clinic Arizona, Scottsdale, Arizona
Amaal J. Starling
3   Department of Neurology, Mayo Clinic Arizona, Phoenix, Arizona
› Author Affiliations


Background Vestibular migraine (VM) is one of the common causes of episodic dizziness, but it is underdiagnosed and poorly understood. Previous research suggests that otolith reflex pathway performance is often impaired in this patient group, leading to altered perception of roll plane stimuli. Clinically, this perception can be measured with subjective visual vertical (SVV) testing.

Purpose The aim of this study is to compare static SVV performance (absolute mean SVV tilt, variance) in a cohort of patients diagnosed with VM to results obtained from clinically derived normative data.

Study Design Retrospective case review.

Study Sample Ninety-four consecutive patients between 18 and 65 years of age diagnosed with VM were included in this comparison to clinically derived normative data.

Data Collection and Analysis Retrospective chart review was completed. Demographic data, symptom report, and vestibular laboratory results were documented. SVV performance was documented in terms of absolute mean SVV tilt and response variance.

Results Abnormal mean SVV tilt was described in 54% (n = 51) of patients with VM. Including abnormal response variance increased those identified with abnormal presentation to 67% (n = 63). Laboratory findings were insignificant for semicircular canal function, but of those with abnormal ocular vestibular myogenic potential results (n = 30), 77% (n = 23) demonstrated both abnormal SVV and utriculo-ocular reflex performance. There were no associations noted for SVV performance and demographic or other self-report variables.

Conclusion Absolute mean SVV tilt and response variance are often abnormal in patients diagnosed with VM. These findings support theories suggesting atypical intralabyrinthine integration within the vestibular nuclei and cerebellar nodular pathways.


Portions of this manuscript were presented at the annual meeting of the American Balance Society, March 2, 2021.


Any mention of a product, service, or procedure in the Journal of the American Academy of Audiology does not constitute an endorsement of the product, service, or procedure by the American Academy of Audiology.

Publication History

Received: 18 February 2022

Accepted: 30 August 2022

Accepted Manuscript online:
07 September 2022

Article published online:
22 February 2023

© 2023. American Academy of Audiology. This article is published by Thieme.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

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