Benign paroxysmal vertigo (BPV) is a migraine syndrome present in young children that is characterized by an abrupt onset of unsteadiness or ataxia. The vertigo occurs without warning and is most severe once it begins. An episode tends to stop spontaneously in minutes to hours but can last for up to 48 hours. BPV usually occurs in toddlers and typically resolves by age 5, but it can range in duration from anywhere between 3 months to 8 years. [1, 2] Episodes occur in clusters and typically end with sleep. A child with this form of migraine may grab onto something like a chair or a parent with a frightened look and may make repetitive, uncontrolled eye movements known as nystagmus.
Symptoms or signs of BPV include vomiting, pallor, fearfulness, ataxia and nystagmus. Younger children may not be able to describe the episode of vertigo, dizziness or nausea, while in infants there may be uncontrollable crying. [2] During episodes of BPV, there is no loss of consciousness, altered mentation or sensorial changes reported.
When a diagnosis is being made to determine the presence of benign paroxysmal vertigo (BPV), other disorders with similar symptoms are first ruled out, including epilepsy, vestibular disorders and metabolic disorders. Most episodes of BPV are brief, and reassurance is typically all that is necessary. Longer attacks may be treated with anti-emetics. Frequent episodes of BPV may warrant preventative therapy such as cyproheptadine. [1, 2]
References:
- 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.
- Cuvellier JC, Lepine A. Childhood Periodic Syndromes. Pediatr Neurol 2010;42:1-11
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