Benign paroxysmal vertigo of childhood

BPVC presents as recurrent episodes of vertigo that occur without warning and cease spontaneously. These episodes typically last a few minutes, but some children experience episodes lasting for hours. Between episodes, children with BPVC are asymptomatic and function normally.^[3][2][1] Episodes may be triggered by poor sleep or specific foods, although a trigger is not identified in every case.^[1] Unlike in benign paroxysmal positional vertigo (BPPV), episodes are not triggered by a change in head position.^[4]

These episodes may be associated with:

• Nystagmus - rapid, involuntary movements of the eye
• Ataxia - impaired balance and coordination
• Nausea and/or vomiting
• Pale skin
• Feeling of fearfulness
• Sensitivity to light and/or sound
• Visual aura^[1]

Children with BPVC do not lose consciousness during episodes.^[3] Headaches are not typical of this condition.^[1]

Although the specific mechanism is not fully understood, BPVC is thought to occur due to a temporary impairment in blood flow to the inner ear, resulting in reduced oxygen supply to the vestibular system, which normally regulates balance and the body's sense of position.^[1][3]

BPVC is considered to be a type of migraine.^[2][5]

The diagnosis of BPVC is made clinically. According to the International Classification of Headache Disorders ICHD-3 diagnostic criteria (ICHD-3), patients must have experienced at least five episodes of vertigo that occurred suddenly and resolved spontaneously. The episodes must be associated with nystagmus, ataxia, vomiting, pale skin, or a feeling of fearfulness, and cannot be accompanied by loss of consciousness. Hearing and neurologic function must be normal between episodes.^[1]

An electroencephalogram is not needed for diagnosis but may be useful in ruling out other possible causes.^[1]

Although BPVC is one of the most common causes of vertigo in children, there are many other possible causes.

• Vestibular migraine (VM) - Another common cause of vertigo in the pediatric population. Similar to BPVC, VM is a type of migraine and episodic in nature; however, it is characterized by a migrainous headache during episodes of vertigo.^[2]
• Benign paroxysmal positional vertigo (BPPV) - This is the most common cause of vertigo in adults, but it is rarer in children. Unlike BPVC, BPPV is provoked by changes in the head position.^[4]
• Otitis media and Vestibular neuritis - Unlike BPVC, these conditions are both associated with ear pain or fullness, and the vertigo is not episodic.^[3]
• Head trauma
• Brain tumor
• Autonomic dysfunction - This is characterized by light-headedness rather than dizziness.^[1]

BPVC is one of the most common causes of vertigo in children, with an estimated prevalence of 2.6% among the pediatric population.^[1] Females are more likely to develop BPVC than males.^[4] Episodes typically begin between 3 and 6 years of age and resolve by adolescence.^[3]