[Usefulness of spontaneous drawing in the diagnostic guidance of pediatric patients with headache].

Introduction and aims: The diagnosis of headache in children can be challenging due to its clinical variability and inability to verbalize certain symptoms. The use of drawing has been proposed to overcome these difficulties. The objective was to evaluate drawing as a diagnostic tool in primary headaches.

Materials and methods: Cross-sectional and descriptive study to assess the agreement between the 'artistic' diagnosis of headache and the clinical diagnosis. We consider an artistic diagnosis to be the one issued after reviewing the drawing of the patient that was made by a neuropediatrician and two neurologists who are experts in headache. The clinical diagnosis would be the classic diagnosis made in consultation after a complete history and examination in consultation and was issued by another neuropediatrician.

Results: We included 132 patients/drawing (61.1% girls; mean age 12 years) with clinical diagnoses of: migraine (59.1%), tension headache (38.2%), and other headaches (trigeminal autonomic and nummular) (2.7%). The agreement between the artistic and clinical diagnoses in migraine and tension headache was 78.5% and 78.6%, respectively when the drawings were evaluated by a neuropediatrician. This agreement was similar for the migraine drawings assessed by both neurologists (76.3% and 83.6%), but not in the case of tension headache (35.1% and 48.4%). The agreement between neurologists was moderate and similar in both types of headaches (migraine: k 0.51; tension headache: k 0.50).

Conclusions: Headache drawing is a useful instrument in the differential diagnosis of migraine. We suggest its inclusion in the initial diagnostic evaluation of headache in children.