title: Headache sufferers' drawings reflect distress, disability and illness perceptions.
abstract: OBJECTIVE
  Drawings have recently been used with patients with heart problems to assess their perceptions of their illness. This study aimed to investigate whether drawings could be a useful way to assess headache patients' perceptions of their headaches and their reactions.
  
  
  METHODS
  In a cross-sectional study, 65 university students who experienced persistent headaches were asked to draw a picture of how their headaches usually affected them. Drawings were assessed in three ways: they were categorized based on content; their size was measured; and image analysis software assessed their darkness. Associations between drawings, illness perceptions, mood, and health outcomes were assessed.
  
  
  RESULTS
  Twenty-seven people drew an external force to the head and these people had greater ratings of average pain and were more likely to attribute their headache to stress. Darker drawings were associated with greater emotional distress and lower vitality. Larger drawing size was associated with perceptions of worse consequences, worse symptoms, worse emotional representations, lower vitality, higher pain, and more days of restricted activity, lower happiness, and higher sadness.
  
  
  CONCLUSIONS
  Drawings offer an additional way to assess peoples' experience of their headaches and reflect illness perceptions and distress. People draw how they see themselves experiencing their headache and often include expressions and reactions. The inclusion of force to the head, darker drawings, and larger drawings are associated with worse perceptions of the headache and higher pain. Drawings may be a useful way for clinicians to understand patients' experience of pain.
authors.affiliation: Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand. e.broadbent@auckland.ac.nz
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Broadbent
authors.forename: Kate
authors.initials: K
authors.lastname: Niederhoffer
authors.forename: Tiffany
authors.initials: T
authors.lastname: Hague
authors.forename: Arden
authors.initials: A
authors.lastname: Corter
authors.forename: Lisa
authors.initials: L
authors.lastname: Reynolds
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D006261:Headache / Q000175:diagnosis / Q000523:psychology*; D006801:Humans; D007092:Imagination; D008297:Male; D009483:Neuropsychological Tests; D010146:Pain / Q000523:psychology*; D010147:Pain Measurement / Q000379:methods*; D011597:Psychomotor Performance; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D055815:Young Adult