Benign paroxysmal vertigo in childhood. Diagnostic significance of vestibular examination and headache provocation tests

Sixteen children with benign paroxysmal vertigo (BPV) are presented. The great majority had a family history of migraine, neurological and autonomic signs associated with vertiginous attacks, and headache or other sign of the periodic syndrome (motion sickness, cyclic vomiting, abdominal pain) unrelated to the attacks. Vestibular examination, including bithermal caloric and rotational testing with ENG recording, showed normal or transiently decreased vestibular function. Headache provocation tests with nitroglycerin, histamine and fenfluramine were positive in 9 of the 13 patients examined, and in 4 cases induced a typical vertiginous attack instead of headache. BPV can be considered a migraine precursor or a migraine equivalent, attributable to the same vascular and/or biochemical disturbances responsible for migraine.