Benign Paroxysmal Vertigo in Childhood: A Migraine Equivalent

Abstract

The two main problems in defining and classifying the syndrome of benign paroxysmal vertigo (BPV) in childhood are the vestibular function pattern and the relationship between BPV and migraine. 13 children suffering from this syndrome were submitted to complete otoneurological examination, including caloric and rotational labyrinthine stimulation with ENG recording, and to headache provocation tests with nitroglycerin, histamine and fenfluramine. Vestibular responses were normal in all except 2 cases which presented signs of central vestibular impairment at the level of the vestibulocerebellar pathways. Headache provocation tests were positive in 9 out of 10 children, and in 4 cases they induced a typical vertiginous attack instead of headache. In addition, several children had a positive family history for migraine, headache was frequently associated with the crisis and other signs of a ‘periodic syndrome’ (motion sickness, cyclic vomiting, abdominal pain) were present, unrelated to vertiginous attacks. During the follow-up period, some children responded positively to migraine treatment. BPV, like paroxysmal torticollis in infancy and the signs of the periodic syndrome, can be considered a migraine equivalent or a migraine precursor and could be due to the same vascular and/or biochemical mechanisms responsible for the migraine. In children, for anatomical or developmental reasons, these mechanisms could selectively affect parts of the brain stem, including the vestibular nuclei and vestibulocerebellar pathways.

Benign paroxysmal vertigo of childhood: A review of the literature

“…Many children with initial vertigo and suspected BPVC go on to develop migraine (20,22,23,(31)(32)(33)(34). Child migraine is different from adult 'classical' migraine (19) in that the most intense symptom (and common complaint) is usually gastrointestinal upset and fever rather than headache or visual disturbances (31).…”

“…Child migraine is different from adult 'classical' migraine (19) in that the most intense symptom (and common complaint) is usually gastrointestinal upset and fever rather than headache or visual disturbances (31). Also, children's migraine attacks are often more frequent, of shorter duration (lasting less than 2 h) (35), may not be experienced as throbbing (35), and may present with a less clearly defined pattern of prodromal expression.…”

Creatine kinase MB (CK-MB) in benign paroxysmal vertigo of childhood: A new diagnostic marker

“…BPV is probably a common but misunderstood and unrecognized condition in small children. 1,2,[4][5][6][7][8][9][10][11] In our experience, awareness of the condition has increased our detection rate of BPV during the past 6 years. The diagnostic criteria have been purely clinical, and BPV has commonly been a diagnosis of exclusion.…”

“…2 However, caloric tests have in general been normal. [7][8][9] The mechanism for increased CK-MB in BPV remains unknown. We have shown that cTnI levels are normal in BPV, thus excluding a cardiac origin of the CK-MB increase.…”

“…12,13 The recurrent episodes without impaired consciousness and with no signs or symptoms between BPV attacks has also raised speculations whether BPV is a migraine precursor or equivalent. [6][7][8]10,11 There is sometimes also a family history of migraine. CK-MB has never been measured in patients with migraine, although there were 4 children with migraines who had normal CK-MB in our comparison group.…”