Virtual reality-based assessment of visuo-vestibular integration in vestibular migraine and migraine: static and dynamic visual vertical and rod-and-frame tests

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dc.contributor.authorKorkmaz, Hanifi
dc.contributor.authorCiplak, Sibel
dc.contributor.authorAlkahtani, Rania
dc.date.accessioned2026-06-19T06:37:56Z
dc.date.available2026-06-19T06:37:56Z
dc.date.issued2026
dc.departmentMalatya Turgut Özal Üniversitesi
dc.description.abstractBackground: Vestibular migraine (VM) is the most common cause of episodic vertigo, yet its diagnostic markers remain limited. Perception of verticality, measured via static subjective visual vertical (SVV), dynamic SVV (DSVV), and the rod-and-frame test (RFT), provides insight into visuo-vestibular integration. Traditional approaches, however, often test these paradigms in isolation with limited ecological validity. Objective: To evaluate a novel virtual reality (VR)-based protocol combining SVV, DSVV, and RFT to characterize visuo-vestibular integration in VM, migraine without vestibular symptoms (M), and healthy controls (HC). Methods: Fifty participants (VM n = 15, M n = 15, HC n = 20) completed VR-based SVV, DSVV, and RFT assessments using the BalanceVR system. Disability was assessed using the Dizziness Handicap Inventory (DHI) and Migraine Disability Assessment (MIDAS). Between-group differences were analyzed using Kruskal-Wallis tests with Mann-Whitney U post-hoc comparisons. Correlations between orientation measures and questionnaires were assessed using Spearman's rho. Results: VM patients exhibited significantly greater SVV deviations than HC (p = 0.015). DSVV errors were elevated in VM vs. HC (p = 0.040). RFT showed robust group differences (p < 0.001), with the most significant visual dependence in VM. DHI and MIDAS scores were significantly higher in both patient groups than HC (p < 0.001). DSVV (rho approximate to 0.45) and RFT (rho approximate to 0.69) showed stronger correlations with disability than static SVV (rho approximate to 0.30). Conclusion: VM is characterized by difficulties in dynamic and visually complex situations, rather than static balance problems. Combining DSVV and RFT with SVV enhances diagnostic sensitivity, explains patients' daily challenges, and supports rehabilitation approaches aimed at reducing visual dependence and improving sensory balance.
dc.description.sponsorshipPrincess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia [PNURSP2026R425]
dc.description.sponsorshipThe authors would like to thank Princess Nourah Bint Abdulrahman University Researchers Supporting Project number (PNURSP2026R425), Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia.
dc.identifier.doi10.3389/fneur.2025.1710226
dc.identifier.issn1664-2295
dc.identifier.orcid0000-0001-9086-9751
dc.identifier.orcid0000-0003-2164-393X
dc.identifier.pmid41626016
dc.identifier.scopus2-s2.0-105028905525
dc.identifier.scopusqualityN/A
dc.identifier.urihttps://doi.org/10.3389/fneur.2025.1710226
dc.identifier.urihttps://hdl.handle.net/20.500.12899/5298
dc.identifier.volume16
dc.identifier.wosWOS:001673827200001
dc.identifier.wosqualityQ2
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.language.isoen
dc.publisherFrontiers Media Sa
dc.relation.ispartofFrontiers in Neurology
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı
dc.rightsinfo:eu-repo/semantics/openAccess
dc.snmzKA_WOS_20260612
dc.subjectDhi
dc.subjectDynamic Visual Vertical
dc.subjectMidas
dc.subjectMigraine
dc.subjectRod-And-Frame
dc.subjectSubjective Visual Vertical
dc.subjectVestibular Migraine
dc.subjectVirtual Reality
dc.titleVirtual reality-based assessment of visuo-vestibular integration in vestibular migraine and migraine: static and dynamic visual vertical and rod-and-frame tests
dc.typeArticle

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