ORIGINAL RESEARCH article
Front. Neurol.
Sec. Neuro-Otology
Cervical Vestibular Evoked Myogenic Potential Asymmetry, but Not Amplitude, Differentiates Vestibular Migraine During Prolonged Unidirectional Visual Motion
Elvira Cortese 1,2
Hüseyin Nezih Özdemir 3,1
Anca Grigore 4
Patricia Castro 4,5,6
Nehzat Koohi 4
Diego Kaski 4
1. Clinical and Movement Neurosciences, SENSE Research Unit, University College London, London, United Kingdom
2. Escuela de Fonoaudiología, Facultad de medicina, Universidad de Valparaiso, Valparaíso, Chile
3. Ege Universitesi Tip Fakultesi, Izmir, Türkiye
4. Clinical and movement Neurosciences, SENSE Research Unit, University College London, London, United Kingdom
5. School of allied Health Sciences, Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom
6. Escuela de Fonoaudiología, Facultad de Medicina Clinica Alemana, Universidad del Desarrollo, Santiago, Chile
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Abstract
Introduction. Vestibular migraine (VM) is the leading cause of episodic vestibular complaints. It arises from altered brain states that disrupt sensory processing. A reliance on clinical history for diagnosis highlights the need for bedside biomarkers, particularly in emergency settings where misdiagnosis is common. Methods. In this cross-sectional study, 30 VM patients (median-age = 40.5; 27 females) from University College London vestibular clinics and thirty age-gender matched healthy controls (median-age = 32.5; 27 females) were recruited, between May 2024 and October 2025. Cervical vestibular myogenic evoked potential (cVEMP) responses were measured before and after a Unidirectional Visual Motion Stimuli delivered via virtual reality goggles. Results. Mixed linear modelling (MLM) showed no significant effects of group, condition or ear on cVEMP amplitude (all p>.05). MLM on asymmetry revealed a significant effect of group, F (1,57.21) =11.89, p=.001 and condition, F (1, 56.53) = 14.47, p= <.001; but no significant group x condition interaction, F (1, 56.53) = 1.57, p=.215. Spearman correlations showed no association between cVEMP delta amplitude and DHI. VM patients scored higher on all symptom's measures compared with controls (All p<.001). Conclusions. Prolonged unidirectional visual stimulation does not significantly affect cVEMP amplitude responses in VM, limiting its value as a differential diagnostic tool. The need to further explore asymmetry and interaural/interhemispheric sensory integration in VM is underscored.
Summary
Keywords
biomarkers, Cervical Vestibular EvokedMyogenic Potential, vestibular migraine, virtual reality, visual stimulation, visuo-vestibular interactions
Received
22 December 2025
Accepted
22 January 2026
Copyright
© 2026 Cortese, Özdemir, Grigore, Castro, Koohi and Kaski. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Diego Kaski
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