Cyclic Vomiting Syndrome and Benign Paroxysmal Torticollis May Lead to Primary Headache

Cyclic vomiting syndrome (CVS) and benign paroxysmal torticollis (BPT) during infancy are associated with a high risk for developing headache, mostly migraine, later in life, according to the results of a longitudinal study published in Cephalalgia.¹

Episodic syndromes that may be associated with migraine are a group of disorders affecting patients with migraine or with an increased risk for presenting it, and are considered an early life expression of migraine.^2,3 CVS and BPT are episodic syndromes that are well characterized and a frequent cause for specialist consultation in the pediatric population.¹ However, there is a lack of longitudinal studies investigating the prevalence of primary headaches and their characteristics in patients with episodic syndromes that may be associated with migraine.

To address this question, the study investigators administered a questionnaire to 82 parents of pediatric patients with CVS and 33 parents of pediatric patients with BPT. The primary focus was the main clinical features of the disorder and the prognosis. A particular emphasis was placed on the development of headache. The researchers found that 79% of patients with CVS presented with headache during the follow-up period, with a mean age at onset of 6 years. Of the patients with BPT, 67% suffered from headache during the follow-up period, with a mean age at onset of 5 years.

The investigators caution that contacting patients via phone calls and/or email may have interfered with the applicability of the diagnostic criteria, especially in this patient population. Despite this limitation, they believe that it did not interfere with the percentage of patients diagnosed with an episodic syndrome who went on to develop headache.

The study investigators ultimately concluded that, “The present study shows that CVS and BPT are associated with a high risk of subsequent development of primary headache (migraine and tension-type headache).”¹ In addition, the majority of patients presented with more than 1 episodic syndrome before developing primary headache, suggesting an age-dependent expression of migraine and migraine-like symptoms. More longitudinal studies with a larger sample size are needed to confirm the relationship between and underlying pathophysiology of episodic syndromes and subsequent primary headaches.

References

1. Moavero R, Papetti L, Bernucci MC, et al. Cyclic vomiting syndrome and benign paroxysmal torticollis are associated with a high risk of developing primaryheadache: A longitudinal study [published online April 13, 2019]. Cephalalgia.  doi:10.1177/0333102419844542

2. Lagman-Bartolome AM and Lay C. Pediatric migraine variants: A review of epidemiology, diagnosis, treatment, and outcome. Curr Neurol Neurosci Rep. 2015;15:34.

3. Gelfand AA. Migraine and childhood periodic syndromes in children and adolescents. Curr Opin Neurol. 2013;26:262-268.