Kids' drawings can help docs diagnose migraine

NEW YORK, Mar 05 (Reuters Health) - Drawings done by young headache sufferers that describe and locate their pain can help doctors diagnose whether or not the child has a migraine, according to researchers.

"The study transpired because I became so struck by the details and fascinating pictures that my headache patients were drawing," lead investigator Dr. Carl E. Stafstrom of Tufts University School of Medicine in Boston, Massachusetts, told Reuters Health. The pictures may offer insight into children's headaches and provide information the children can't express verbally because they are too young or because they may be more adept at drawing.

Stafstrom asked 226 children to make pencil drawings that showed the location of their pain, what their pain feels like, and any other changes or symptoms that accompany the headache. He then completed the clinical evaluation and diagnosed the headache type without examining the pictures. He diagnosed migraine or mixed headache with a prominent migraine component in 57.5% of the children.

Later, Drs. Kevin Rostasy and Anna Minster, also pediatric neurologists, were asked to use the pictures to decide whether their features were more consistent with migraine or nonmigraine headache. They categorized 139 pictures as migraine-related. Compared to clinical evaluation, analysis of drawings correctly identified migraines 93% of the time.

Drawings that showed pain around the eye socket always indicated migraine, the authors note. Pictures of the child lying down, drawings showing blind spots or other defects in the visual field, depictions of light intolerance and illustrations of gastrointestinal symptoms were all also closely correlated to a diagnosis of migraine.
Seventeen percent of children who drew pictures showing pounding or throbbing pain were diagnosed with nonmigraine headache. Diagnoses were nearly equally divided for those showing dizziness, sadness or crying, or different pain locations, including pain on one side of the head. The appearance of a tight band around the head or of squeezing pain was significantly associated with muscle tension-type headaches.

The children's age did not affect their ability to accurately render their headache type. In fact, those younger than 8 did somewhat better than older children. The youngest patient, a 4-year-old boy, drew rocks pounding his forehead.

Stafstrom recommends this technique to anyone who treats children with headaches. "It costs nothing, it's fun for kids and the doctors, and can be done while the patient is still in the waiting room so it doesn't take time from the clinic visit," he noted.

He is now beginning to test the theory that such drawings can demonstrate a patient's response to therapy, and is also using the technique to analyze patients with epilepsy.