To study the differences between epileptic and nonepileptic head drops, 351 episodes in 24 children were analyzed by EEG-videotelemetry monitoring. Drops were classified as either epileptic or nonepileptic depending on the presence or absence of concomitant ictal EEG discharges. Ictal discharges included generalized spike-wave, polyspike-wave, bilateral sharp wave, generalized delta, and generalized beta activity. Children with epileptic drops (group I) were similar to children with nonepileptic drops (group II) with respect to age, sex, number of recorded episodes, and presence of mental retardation or other abnormalities on neurologic examination. Group I patients had a significantly higher prevalence of ictal changes in facial expression, subtle myoclonic extremity movements, generalized interictal EEG discharges, and other seizure types. Drops characterized by rapid head descent followed by slow recovery to the upright position were significantly more common in group I patients, whereas drops in which the velocity of recovery matched that of head descent (head nods) were equal in the two groups. Repetitive nods (head bobs) were observed exclusively in group II patients. These clinical and electrophysiologic features may assist in differentiating epileptic from nonepileptic head drops in children.