Video-Case Study Pediatric Migraine – Benign Paroxysmal Vertigo of Childhood/Infancy

According to the International Headache Society (IHC, 2014), pediatric migraine and specifically BPV of Childhood is classified as one of the six (6) categories of migraine. Most prevalent onset between the ages of one to five years of age. The episodes are characterized by brief attacks of incapacitating vertigo, often accompanied by nausea and emesis and postural imbalance. This condition is often a diagnosis of exclusion and there is no specific test to diagnose the condition. As migraine is best described as a genetic neurologic condition, one or both of the parents typically has history of some form of migraine. It is unrelated to BPPV associated with otoconia displacement. Although somewhat rare in infants and young children and is not uncommonly seen in children post head trauma.

A common co-morbidity of the condition in younger children is a torticollis, a unilateral contraction of the sternocleidomastoid (SCM) muscle causing a flexion of the neck and head. Once the child has been identified and managed, it will be helpful to evaluate balance function through behavioral assessment and cVEMPs.

To better familiarize the reader with the symptoms of the condition as reported by parents or caregivers (it is rarely actually seen in clinic), we are presenting a video interview of a mother who talks about her observations. In addition, we have included  a short video of part of the child’s behavioral evaluation as well as the cVEMP testing.  It is important to remember, that BPV of childhood is often a diagnosis of exclusion.  Testing results therefore may be unremarkable.

References:

1. Gans, RE, Evaluation and Management of Vestibular Function in Infants and Children with Hearing Loss, In JR Maddell and C Flexer, (Eds)Pediatric Audiology: Diagnosis, technology and Management 2nd Edition, Thieme, 2014

2. Ralli, G., Atturo, F., de Filippis, C., Idiopathic benign paroxysmal vertigo in children, a migraine precursor, International Journal of Pediatric Otolaryngology, 735 (2009) 516-518

3. Gans, RE , Pediatric Vestibular Conditions, In Gans RE, (Ed) Balance Disorders: Evaluation and Management in Children and Adults, Thieme, Expected release 2018