Objective:

To define the dual profile of visual-vestibular integration in vestibular migraine (VM) by concurrently evaluating visually enhanced vestibulo-ocular reflex (VVOR) and vestibulo-ocular reflex suppression (VORS).

Approach:

Key Findings:

• VM patients showed significantly higher VVOR gains (mean: 1.4 ± 0.2) compared to controls (1.2 ± 0.2, p = 0.003).
• VM patients had markedly elevated VORS gains (0.5 ± 0.2) versus controls (0.2 ± 0.1, p < 0.001).
• VVOR demonstrated a linear relationship with VM risk, while VORS showed a significant nonlinear S-shaped association.
• High VORS gain (≥0.39) was strongly associated with VM (OR = 0.01, p < 0.001).

Interpretation:

The study identifies a threshold-dependent VORS suppression deficit as a specific indicator of VM-related central dysfunction.

Limitations:

• Retrospective design may introduce selection bias.
• Sample size may limit generalizability of findings.

Conclusion:

The findings refine the physiological understanding of VM.

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