What is benign paroxysmal torticollis?

Benign paroxysmal torticollis (BPT) begins during infancy and early childhood. Children with BPT presents with repeated attacks of head tilting (torticollis) with side switching between attacks. The attacks tend to occur with a certain predictable pattern (ex. monthly). This condition may be associated with delay in development. BPT is one of the rarest migraine variants. 

How do you diagnose benign paroxysmal torticollis?

BPT is diagnosed in children experiencing recurrent attacks of tilting of the head (torticollis) to either side during infancy and early childhood for minutes to hours. Associated symptoms may include irritability, lack of color (pallor), fearfulness or unsteady when walking (ataxia). The patient reports feeling well between episodes. 

What are the available treatments for benign paroxysmal torticollis?

Since BPT is so rare, there are no high-level studies indicating treatment options. Due to the infrequent and brief nature of the episodes often reassurance for the parents is all that is required. Reassurance is important. 

Should the attacks become more frequent, parents may discuss treatment options with their child’s doctor such as oral medications including anti-inflammatories, anti-nausea agents, or a preventive medication (ex. Topiramate). 

Will my child suffer from this condition forever?

BPT resolves over time. It typically starts to improve by age two, resolving completely by age three or four. It is common for a child diagnosed with BPT to develop migraine headaches by age four. Many children develop other migraine variants such as abdominal migraine (See this post).  

References:

Gelfand A. Episodic syndromes of childhood associated with migraine. Current Opinion Neurology.2018;31:281-285.

Lagman-Bartolome AM, Lay C. Pediatric Migraine Variants: A review of epidemiology, diagnosis, treatment and outcome. Current Neurology and Neuroscience.2015;12:1-14.

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