For decades, psychiatrists have used children's drawings to analyze feelings, hidden fears and self-perception.
Why not use the technique to examine headache pain in children?
That was the idea of Dr. Carl Stafstrom, a pediatric neurologist. In a study released today in the medical journal Pediatrics, Stafstrom presents strong evidence that children's drawings can help doctors diagnose and plan treatments for children's headaches.
Stafstrom's research began about a decade ago. He gave children paper and pencils to keep them busy while he conferred with parents. He asked the youngsters to draw pictures of their headaches.
The results surprised Stafstrom, now an associate professor of neurology and pediatrics at the University of Wisconsin Medical Center in Madison.
"Over time, I was amazed by the elaborate detail and insight that the headache drawings were taking on," he says. "A picture is worth a thousand words."
To turn his hunch into a clinical study, Stafstrom collected hundreds of drawings over several years, shipped the artwork to two pediatric neurologists and asked them to decide whether each headache depicted was a migraine or nonmigraine. Then Stafstrom compared the artistic and clinical diagnoses.
"The results of the study are remarkable in terms of the ability of the drawing itself to predict the headache type as well as provide insight into the child's feelings of pain," he says. Artistic diagnoses correctly identified migraine headaches 87 percent of the time and nonmigraine headaches 91 percent of the time.
Drawings from children suffering migraines graphically show severe pain from objects hitting the head - hammers, baseball bats, high- heeled shoes, bottles or rocks. Other artistic features suggest migraine symptoms like nausea, a need to lie down, a dislike of light and sound, and visual auras, such as sparkling spots, drifting colored lights or blurry vision.
In contrast, tension headaches, considered the most common kind of headaches in children, showed up in the drawings as a squeezing pain; for example, a tight rope or band wrapped around the head. Facial expressions, such as frowns or crying, were of little value in diagnosing headaches because they were seen equally in migraine and nonmigraine headaches.
It's important to diagnose the type of headache accurately because the treatments are very different, Stafstrom says.
Migraines, now believed to come from errant electrical pulses from the brain, might be treated with medicines to interrupt the electrical process, like anticonvulsants or beta blockers. Tension headaches are more likely to be treated with simple pain relievers, though daily tension headaches might require lifestyle changes and antidepressants.
Migraines, though, can be difficult to diagnose in children because no medical test confirms their existence, Stafstrom says. Doctors must rely on what patients tell them about their symptoms.
For patients younger than 8, that can be challenging. Such youngsters don't fully understand the pain they feel and are vague when describing it.
Their drawings, however, proved in Stafstrom's study to be the most accurate in predicting whether they had a migraine or not. Artistic diagnoses were right 94 percent of the time for children under 8, compared to 89 percent of the time for children 8 to 10 and 86 percent of the time for those ages 11 and older.
Kids who can draw little more than stick figures are clear when choosing symbols for their pain, such as hammers pounding on their heads.
Even among children ages 9 1/2 to 16, 25 percent are unable to describe even one characteristic of their headaches, according to earlier research quoted in Stafstrom's study. For those children, also, the drawings could provide the key.
"It is a very unique approach," Stafstrom says. "It's a relatively simple approach that pediatricians can use in their offices."
Not only that, drawings give the kids a feeling of more control over their headaches. In addition to supporting a clinical diagnosis, the drawings can give doctors - and parents - insights into how the children feel about their pain, which can help in counseling them, Stafstrom says.
Before you go get the crayon box and paper, Stafstrom cautions that only doctors with experience in diagnosing headaches should try to eke a diagnosis out of a child's drawings.
"Of course, parents may ask their children to draw headache pictures at home," he says.
But take the drawings to the doctor's office, he suggests, and leave the diagnosis up to the professionals.
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