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benign paroxysmal torticollisBenign paroxysmal torticollis (BPT) is a rare migraine syndrome that includes recurrent episodes of head tilt to one side which spontaneously ends after a period of minutes to days. The condition occurs in infants and small children, with an onset during infancy between the ages of 2-8 months that usually stops by the ages of 3-5. [1] The head tilt during BPT episodes can be to either side, and the headache can be returned to the neutral midline position during attacks. Symptoms of cold and pallor, irritability, malaise, vomiting and ataxia (in older children) are associated with this migraine syndrome. The frequency of attacks may initially be monthly and decline in frequency and duration as the patient gets older. [2]

There are other conditions with similar symptoms that need to be ruled out before a diagnosis of BPT is made, such as gastroesophageal reflux or epilepsy. [3] The parent should make a record of an attack, which can prove very beneficial in obtaining an accurate diagnosis.

As patients with BPT get older, their condition may evolve into benign paroxysmal vertigo (BPV), cyclical vomiting syndrome (CVS), abdominal migraine, motion sickness and/or migraine with aura, or it may completely go away. A family history of migraine and motion sickness is also common. [3]

It’s important to know that BPT is a benign syndrome. Episodes of this migraine syndrome can be treated with cyproheptadine.

References: 

  1. Lewis DW, Bigal ME, Winner P. Migraine and the Childhood Periodic Syndromes. In: Winner P, Lewis DW, Rothner AD, editors. Headache in Children and Adolescence, 2 ed. Ontario, Canada: B.C. Decker, 2008: 37-55.
  2. Giffin NJ, Benton S, Goadsby PJ. Benign paroxysmal torticollis of infancy: Four new cases and linkage to CACNA1A mutation. Dev Med Child Neurol 2002;44:490-3.
  3. Cuvellier JC, Lepine A. Childhood Periodic Syndromes. Pediatr Neurol 2010;42:1-11

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