P009 | THE USE OF DRAWING IN PEDIATRIC HEADACHES: A CROSS-CULTURAL ANALYSIS OF THE LITERATURE

V. Raieli¹, F. Cernigliaro², E. Correnti¹, D. Lopes¹, A. Messina³, C. Balzanelli⁴, G. Santangelo¹, R. Nardello⁵ | ¹Child Neuropsychitry Unit – h. “Di Cristina “Arnas civico”, Palermo, Italy; ²Child neuropsychiatry unit – asp 6 -Palermo, Italy; ³Neurotologic Center “Regina Margherita” Palermo, Italy; ⁴Vertigo Center at San Bernardino Outpatient Clinic, Salò, Italy; ⁵Child neuropsychiatry dept. – University of Palermo, Italy

Abstract

Background. The scientific literature reports several studies highlighting the usefulness of drawing in the diagnosis of primary headaches, demonstrating good sensitivity and specificity, especially in children under 10 years of age, where verbal methods are not always appropriate. (1)Furthermore, in an outpatient setting, drawing facilitates the child's relationship with the clinician and allows for the exploration of emotions, moods, and fears.However, when analyzing drawings, it seems reasonable to hypothesize the influence of various factors such as gender, age, cultural, and socio-geographical contexts.The objective of this study was therefore to analyze published collections of pediatric headache drawings in the literature to identify geographical similarities and differences, on a symbolic and iconographic level, with further distinctions by age and gender.
Methods. The study material consists of scientific articles that were the subject of a recent study of ours (1) and which use drawing as an assessment tool. We selected studies on children and adolescents (0–18 years) that involved the production of spontaneous drawings referring to headache or related symptoms.
Results. The comparative analysis of the different studies indicates universal and consistent characteristics, including the depiction of the location, intensity, and pulsation of pain. However, three main factors—age, gender, and cultural context—influence this graphic representation. Age appears to be the primary factor, with more structured and detailed representations occurring with cognitive development. Gender differences are relatively limited, although females express the emotional aspects of pain more. It is interesting to note how cultural context influences the ways in which pain is symbolized and interpreted. Drawing appears more expressive in Anglo-Saxon and North American contexts, more communicative in Latin American contexts, more clinically and diagnostically oriented in European contexts, and more phenomenological and perceptual in Eastern European contexts.
Conclusions. The results suggest that interpretation of drawings should take into account the child's developmental level and cultural context to improve understanding of their subjective experience.
References. 1. Ferro F, Gaspari C, Manfrè G, et al. Children's headache through drawings: a narrative review and a portrait gallery. Life (Basel) 2025;15:996.