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Benign paroxysmal migraine variants of infancy and childhood: Transitions and clinical features
Jacob Brodsky1, Karampreet Kaur2, Talia Shoshany3
1Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA; Harvard Medical School, 243 Charles Street, Boston, MA, 02114, USA.
Insights
Childhood migraine variants like benign paroxysmal torticollis (BPTI) and vertigo (BPVC) can progress to vestibular migraine (VM), a phenomenon termed the "vestibular march." Early screening for motor delay and hearing issues is recommended.
Area of Science:
- Pediatric Neurology
- Vestibular Disorders
- Migraine Variants
Background:
- Childhood migraine variants include benign paroxysmal torticollis of infancy (BPTI) and benign paroxysmal vertigo of childhood (BPVC).
- These disorders share similarities and may represent a spectrum of conditions.
Purpose of the Study:
- To review the clinical experience with BPTI and BPVC.
- To determine the incidence of children transitioning between BPTI, BPVC, and vestibular migraine (VM).
Main Methods:
- Retrospective review of medical records.
- Patients diagnosed with BPTI, BPVC, and/or VM at Boston Children's Hospital between 2012-2016 were included.
- Analysis of patient progression between disorders.
Main Results:
- Abnormal rotary chair testing correlated with BPTI to BPVC progression (p=0.045).
- Motor delay and balance impairment were common in BPTI and BPVC patients.
- Significant transition rates were observed: 42.9% of BPTI patients developed BPVC, and 15.4% of BPVC patients developed VM.
Conclusions:
- A developmental progression, termed the "vestibular march," exists from BPTI to BPVC and then to VM.
- Most BPTI cases resolve, but progression is possible.
- Screening for hearing loss, otitis media, and motor delay is crucial for children with BPTI and BPVC.
Introduction:
Migraine variant disorders of childhood include benign paroxysmal torticollis of infancy (BPTI) and benign paroxysmal vertigo of childhood (BPVC). This study aimed to review our experience with BPTI and BPVC and determine the incidence of children transitioning between each of these disorders and to vestibular migraine (VM).
Methods:
We retrospectively reviewed the medical records of patients seen at the Balance and Vestibular Program at Boston Children's Hospital between January 2012 and December 2016 who were diagnosed with BPTI, BPVC, and/or VM.
Results:
Fourteen patients were diagnosed with BPTI, 39 with BPVC, and 100 with VM. Abnormal rotary chair testing was associated with progression from BPTI to BPVC (n = 8, p = 0.045). Eight (57.1%) patients with BPTI and 11 (28.2%) with BPVC had motor delay. Eleven (78.6%) patients with BPTI and 21 (53.8%) with BPVC had balance impairment. Six BPTI patients developed BPVC (42.9%), six BPVC patients developed VM (15.4%), and two patients progressed through all three disorders (2%). One BPTI patient progressed directly to VM.
Discussion:
Most patients with BPTI will experience complete resolution in early childhood, but some will progress to BPVC, and similarly many patients with BPVC will progress to VM. Parents of children with these disorders should be made aware of this phenomenon, which we refer to as "the vestibular march." Children with BPTI and BPVC should also be screened for hearing loss, otitis media, and motor delay.
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