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Review
. 2020 Sep 24;10(10):664.
doi: 10.3390/brainsci10100664.

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

Esteban Obrero-Gaitán  1 , María Manrique-Navarro  2 , Miguel Ángel Lérida-Ortega  1   3   4 , Daniel Rodríguez-Almagro  1 , María Catalina Osuna-Pérez  1 , Rafael Lomas-Vega  1
Affiliations
Review

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

Esteban Obrero-Gaitán et al. Brain Sci. .

Abstract

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.

Keywords: migraine; perception of visual verticality; primary headache disorders; sensory integration; subjective visual vertical; tension-type headache.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Visual, vestibular, and proprioceptive contributions to build the sense of verticality.
Figure 2
Figure 2
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart.
Figure 3
Figure 3
Forest plot for the perception of visual verticality, assessed with the SVV test, in patients with primary headache disorders.
Figure 4
Figure 4
Forest plot for the perception of visual verticality, assessed with the SVV test, in subgroups of patients with migraine or tension-type headache.
Figure 5
Figure 5
Forest plot for the subgroup analysis in patients with PHD with fixed and non-fixed head condition.
Figure 6
Figure 6
Forest plot for the subgroup analysis in patients with PHD using the bucket test or rod projected test in a dark room to measure the SVV.
See this image and copyright information in PMC

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