# Elucidating the neural mechanisms of spatial disorientation in vestibular migraine

> **NIH NIH R01** · JOHNS HOPKINS UNIVERSITY · 2021 · $441,753

## Abstract

Vestibular migraine (VM) is among the leading causes of dizziness in general population. The VM pathophysiology
is unknown with a major gap being lack of understanding neural mechanisms underlying symptoms related to spatial
disorientation in these patients. While VM patients do not have peripheral vestibular dysfunction, their symptoms
triggered by changes in the head position or visual surroundings indicate dysfunction at the high-level cortical mech-
anisms or their interactions with the lower-level vestibular functions. We have studied spatial orientation in a novel
context of Bayesian spatial model (BSM), which is built on decades of insights into neurophysiology of multisensory
processing and integration for spatial orientation. Within this framework, sensory components that encode head
and eye positions are taken into account to quantify spatial orientation. In prior work from our group, we showed
that VM patients have altered spatial orientation with changes in the head tilt position as well as heightened sensi-
tivity to visual motion. These findings suggest abnormal sensory integration for spatial orientation in VM patients.
Using the effects of transcranial magnetic stimulation (TMS), we have shown that the multisensory vestibular cortex
within the temporoparietal junction (TPJ) is involved in sensory integration for spatial orientation. We have also
developed a novel neurophysiological technique that can probe modulating effect of TPJ on vestibulo-ocular func-
tion, using transcranial direct current stimulation (tDCS). Through application of these methods, the overall objective
of this proposal is to delineate mechanisms and neural correlates of VM spatial disorientation with links to clinical
symptoms in patients. Our central hypothesis is that VM patients exhibit altered TPJ function within the vestibulo-
cortical network associated with abnormal sensory integration for spatial orientation. To test this hypothesis, we (i)
uncover distinct sensory mechanisms related to VM spatial disorientation, (ii) investigate whether such mechanisms
are linked to clinical signs and symptoms (validated measures of visuospatial symptoms and postural instability),
and (iii) delineate TPJ contributions to VM pathophysiology considering its role in both high and low level vestibular
functions, and whether TPJ can be targeted using TMS to modulate spatial disorientation in these patients. These
steps are crucial towards devising effective treatment strategies for debilitating dizziness and spatial disorientation
in VM patients.

## Key facts

- **NIH application ID:** 10210380
- **Project number:** 5R01DC018815-02
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Amir Kheradmand
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $441,753
- **Award type:** 5
- **Project period:** 2020-07-06 → 2025-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10210380

## Citation

> US National Institutes of Health, RePORTER application 10210380, Elucidating the neural mechanisms of spatial disorientation in vestibular migraine (5R01DC018815-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10210380. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*