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Children may be able to express themselves more effectively by drawing than by talking. A paediatric neurologist in Boston, Massachussetts (
) asked children with headache to make a drawing of their problem.
Two hundred and twenty-six consecutive patients aged 4–19 years (mean 11 years) attending a paediatric neurology clinic because of headache were asked to make a drawing and all did so. They were asked to draw a picture of themselves having a headache. Where is your pain? What does your pain feel like? Are there any other changes or symptoms that come before or during your headache that you can show me in a picture. The paediatric neurologist then made a diagnosis (migraine or nonmigraine headache) from standard clinical assessment without seeing the drawing. At the end of the consultation, after the diagnosis was recorded, the child was asked to explain the drawing and notes of this explanation were made. Two other paediatric neurologists later analysed the drawing independently of each other and decided on a diagnosis of migraine or nonmigraine headache from this analysis. Features analysed included the depicted severity and character of the headache and representations of nausea or vomiting, lying down, visual disturbance, laterality, or confusion but they relied on overall impression rather than counting specific features.
Compared with the clinical diagnosis the diagnoses from the drawings were 93% sensitive, 83% specific, and had a positive predictive value of 87% for the diagnosis of migraine. Drawings which depicted focal neurological features, periorbital pain, recumbency, photophobia, scotomata, or nausea or vomiting had a positive predictive value of over 90% and depiction of a severe or pounding headache was more than 80% predictive. A selection of drawings, several with hammers attacking the head, is included in the paper.
Asking children to make drawings to depict their headaches may help in diagnosis and the children usually enjoy doing it.
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