title: Children's Headache: Drawings in the Diagnostic Work Up.
abstract: OBJECTIVE
  This study aims to evaluate the drawings effectiveness in childhood headache assessment.
  
  
  BACKGROUND
  Headache is a common cause of pain in children. Although drawings have been used in childhood to recognize psychological insights and pain perception, they were rarely used for headache characterization.
  
  
  METHODS
  We collected drawings from 67 subjects with cephalalgia during a 22-month timeframe. The clinical diagnosis was made according to the 2nd edition of The International Headache Classification. Drawings were independently categorized as migraine or tension-type headache (TTH) by two child neuropsychiatrists blinded to the clinical data. Cohen kappa for interrater agreement, sensitivity, specificity, and positive predictive value (PPV) were calculated. Subjects were also divided into three age groups to assess the influence of age. Finally, a control group of 90 subjects was collected and K-means cluster analysis was performed.
  
  
  RESULTS
  The drawings had a sensitivity of 85.71 and 81.48%, a specificity of 81.48 and 85.71%, and a PPV of 85.71 and 81.48%, for migraine and TTH diagnosis, respectively. Drawings by the older age group showed the highest predictability degree. Finally, by mean of cluster analysis, 59 of the 67 patients were correctly classified, whereas control subjects were similarly distributed between the two clusters.
  
  
  CONCLUSIONS
  Drawings are a useful instrument for migraine and TTH differential diagnosis. Thus, we suggest their inclusion in childhood headache diagnostic assessment.
authors.affiliation: Child Neuropsychiatry Unit, Neuroscience Department, Parma University, Parma, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Mazzotta
authors.affiliation: Child Neuropsychiatry Unit, Neuroscience Department, Parma University, Parma, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Pavlidis
authors.affiliation: Child Neuropsychiatry Unit, Neuroscience Department, Parma University, Parma, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Cordori
authors.affiliation: Child Neuropsychiatry Unit, Neuroscience Department, Parma University, Parma, Italy.
authors.forename: Carlotta
authors.initials: C
authors.lastname: Spagnoli
authors.affiliation: Headache Centre, Modena University, Modena, Italy.
authors.forename: Luigi Alberto
authors.initials: LA
authors.lastname: Pini
authors.affiliation: Child Neuropsychiatry Unit, Neuroscience Department, Parma University, Parma, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Pisani
mesh_terms: D000293:Adolescent; D001154:Art; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D006261:Headache / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008881:Migraine Disorders / Q000150:complications / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D018781:Tension-Type Headache / Q000150:complications / Q000175:diagnosis*