Children's Headache Drawings Help Neurologists

March 21, 2002

If you're old enough to read this article, chances are you are old enough to remember having had a headache. Maybe your headache felt as if your head was being hit by a hammer; maybe it felt as if your head was in a vise.

Headaches are usually divided into two main types:

Migraine Headaches - repeated headaches with additional symptoms such as nausea, vomiting and sensory (visual) disturbances. Migraine headaches often feel throbbing or pulsating and may occur on only one side. Some people with migraine headaches are sensitive to sounds and lights.

Nonmigraine Headaches - headaches due to muscle tension, head trauma or other cause.

Migraine and nonmigraine headaches have different treatments, so it is important for doctors to know what type of headache a person is suffering from. Headaches are a common reason why children visit the doctor, but it can be difficult to determine the type of headache in children because they may have trouble describing their pain. A new study published in the journal Pediatrics reports a new way for doctors to diagnose headaches: ask children to DRAW themselves having a headache!

Young Artists

The research team led by Dr. Carl E. Stafstrom asked 226 children (ages 4 to 19 years old) who complained of headaches to:

"Please draw a picture of yourself 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?"

After the headache pictures were drawn, a neurologist examined each child to diagnose the child's headache type (migraine or nonmigraine type). The neurologist did NOT see the child's headache drawing before this clinical examination. The headache drawings were analyzed and classified (migraine or nonmigraine type symptoms) by two doctors who did NOT know the results of the clinical examination.

Drawings Tell the Headache Story

Based on the clinical examination, 130 children were diagnosed with migraine headaches and 96 children were diagnosed with nonmigraine headaches. Migraine headache drawings often showed the pounding or throbbing nature of a migraine. Some drawings of migraine headaches featured visual symptoms, upset stomachs, and nausea. Drawings of nonmigraine headaches did not show these features. Rather, children with nonmigraine headaches were drew pictures with objects tightening around their heads and with general sadness and pain.
Headache Drawings

Migraine Headache
9-yr-old boy

Migraine Headache
18-yr-old girl

Nonmigraine Headache
9-yr-old girl

Nonmigraine Headache
10-yr-old boy
(These four black and white drawings are from Stafstrom, C.E., Rostasy, K. and Minster, A, The usefulness of children's drawings in the diagnosis of headache. Pediatrics, 109:460-472, 2002, and are being used with the permission of C.E. Stafstrom.)
The researchers compared the diagnosis from the clinical exam to the diagnosis based on the drawings. They found that the clinical diagnosis and the drawing diagnosis for migraine headaches MATCHED 93.1% of the time. Clinical and drawing diagnosis for nonmigraine headaches MATCHED 82.7% of the time. The researchers found that migraine headache drawings predicted a clinical diagnosis of a migraine headache 87.1% of the time; nonmigraine headache drawings predicted nonmigraine clinical diagnosis 90.6% of the time. Even the drawings by young children (less than 8 years old) were accurate predictors of the type of headache: the drawing diagnosis and clinical examination diagnosis of migraine disagreed with each other only 5.6% of the time.

Another Tool in the Doctor's Bag?

This experiment demonstrates that children's drawings are capable of telling the difference between migraine and nonmigraine headaches. The researchers encourage doctors to add this method to their diagnositic tools. Perhaps the next time you visit the doctor's office, you will find paper, pencils and pens in the waiting room and the first question you will be asked is:

"Please draw a picture of yourself and what your pain feels like."

Cartoon depicting the cause of a headache by Sam C., 8 years old

Reference and further information about headaches:

  1. Stafstrom, C.E., Rostasy, K. and Minster, A. The usefulness of children's drawings in the diagnosis of headache. Pediatrics, 109:460-472, 2002.
  2. American Council for Headache Education
  3. How Do Pain Relievers Work? - from Kid's Health
  4. International Association for the Study of Pain
  5. The National Headache Foundation
  6. National Institute of Neurological Disorders and Stroke

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