1.6.3 Benign paroxysmal torticollis

Description:
Recurrent episodes of head tilt to one side, perhaps with slight rotation, which remit spontaneously. The condition occurs in infants and small children, with onset in the first year.

Diagnostic criteria:
A. Recurrent attacks1 in a young child, fulfilling criteria B and C
B. Tilt of the head to either side, with or without slight rotation, remitting spontaneously after minutes to days
C. At least one of the following associated symptoms or signs:

    1. pallor
    2. irritability
    3. malaise
    4. vomiting
    5. ataxia2

D. Normal neurological examination between attacks
E. Not attributed to another disorder.

Notes:
1. Attacks tend to recur monthly.

2. Ataxia is more likely in older children within the affected age group.

Comments:
The child’s head can be returned to the neutral position during attacks: some resistance may be encountered, but can be overcome.

The differential diagnosis includes gastro-oesophageal reflux, idiopathic torsional dystonia and complex partial seizure, but particular attention must be paid to the posterior fossa and craniocervical junction where congenital or acquired lesions may produce torticollis. These observations need further validation by patient diaries, structured interviews and longitudinal data collection.

1.6.3 Benign paroxysmal torticollis may evolve into 1.6.2 Benign paroxysmal vertigo or 1.2 Migraine with aura (particularly 1.2.2 Migraine with brainstem aura), or cease without further symptoms.