Division of Pediatric Neurology, Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Division of Pediatric Neurology, Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Pediatr Neurol. 2018 Feb;79:40-44. doi: 10.1016/j.pediatrneurol.2017.10.020. Epub 2017 Nov 5.
This study aimed to determine whether children's headache drawings can distinguish between pseudotumor cerebri and migraine.
Headache features associated with pseudotumor cerebri (pseudotumor; idiopathic intracranial hypertension) are nonspecific and are difficult to distinguish clinically from migraines. Children's headache drawings have a high predictive value for migraine versus nonmigraine headaches. We hypothesized that drawings could help to differentiate pediatric headaches due to pseudotumor cerebri from those associated with migraines.
Children aged six to 18 years old attending university hospital pediatric neurology clinics were asked to draw a picture of how their headache feels. From our database of children's headache drawings, pictures by children with clinically diagnosed pseudotumor were compared with migraine drawings.
Headache drawings of 21 children (16 females) with pseudotumor were compared with those of 518 children with migraine. Pseudotumor drawings depicted a variety of symptoms including pounding pain (n = 11), pressure-like pain (n = 3), photophobia (3), dizziness (1), and recumbency (1). Severe pain indicators included hammers, bombs, anvil, and vise grip. Positive visual phenomena included scintillations, scotomata, or blurring (n = 8). Negative visual phenomena included field defects (n = 2). Pseudotumor drawings were similar to migraine drawings except that 6 of 21 pseudotumor drawings (28.6%) depicted diplopia (crossed eyes, double images), whereas only three of 518 migraine drawings (0.6%) depicted diplopia (P < 0.000001).
Diplopia was depicted in a significantly higher percentage of pseudotumor drawings than migraine drawings. In all other respects, headache drawings by children with pseudotumor cerebri were similar to those drawn by children with migraine.
本研究旨在确定儿童头痛画是否能区分假性脑瘤和偏头痛。
与假性脑瘤（假性肿瘤；特发性颅内高压）相关的头痛特征不具有特异性，临床上难以与偏头痛区分。儿童头痛画对偏头痛与非偏头痛头痛的预测价值很高。我们假设这些画可以帮助区分因假性脑瘤引起的小儿头痛和与偏头痛相关的头痛。
我们邀请了在大学医院儿科神经病学诊所就诊的 6 至 18 岁的儿童画一幅他们头痛的感觉的画。从我们的儿童头痛画数据库中，将假性脑瘤患儿的画与偏头痛患儿的画进行比较。
将 21 名（16 名女性）患有假性脑瘤的患儿的头痛画与 518 名偏头痛患儿的画进行了比较。假性脑瘤画描绘了各种症状，包括重击痛（n=11）、压迫样疼痛（n=3）、畏光（3）、头晕（1）和卧床（1）。严重疼痛指标包括锤子、炸弹、铁砧和虎钳。阳性视觉现象包括闪烁、盲点或模糊（n=8）。阴性视觉现象包括视野缺损（n=2）。假性脑瘤画与偏头痛画相似，只是 21 幅假性脑瘤画中有 6 幅（28.6%）描绘了复视（斜视、复视），而 518 幅偏头痛画中只有 3 幅（0.6%）描绘了复视（P<0.000001）。
斜视在假性脑瘤画中比偏头痛画中更为突出。在所有其他方面，假性脑瘤患儿的头痛画与偏头痛患儿的头痛画相似。
