پریشانی نشان دهنده نقشه افراد مبتلا به سردرد، ادراکات ناتوانی و بیماری

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. Conclusion 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.

Recent work has shown that patients' drawings of their illness can reveal their perceptions about the physiology and nature of their illness. Myocardial infarction patients' drawings of their heart captured the extent to which they believed their heart had been damaged, which predicted speed of return to work and self-reported recovery [1]. Furthermore, patients whose drawings of their heart increased in size over the recovery period reported greater anxiety and poorer recovery at follow-up than those whose drawings got smaller [2], suggesting that drawing size can indicate the extent to which the patient is thinking about the illness. This is supported by other research that has shown that larger sizes of heart failure patients' drawings of their heart are associated with higher levels of cardiac anxiety [3]. Using drawings as a technique to assess patients' perceptions of an illness relies on patients' abilities to visualize the affected organ. The heart is a well-known part of the body and more easily drawn than more obtuse organs such as the pancreas or spleen. In this study, we were interested in whether drawing could be a useful method to assess perceptions in another part of the body, the head. Headaches are commonly experienced in the general population, with about 30% of the Western population experiencing at least one headache per year [4]. Annually in the UK, about 3 million days are taken off work due to headache. Research has shown that patients' illness perceptions are important in headache patients. Headache patients who believe that their condition will last a long time and that it has severe personal consequences are more likely to be depressed [5]. The most common attributions for chronic daily headache are psychological, such as stress or overwork. Previous work with children suggests that drawings may be a useful way to assess perceptions in headache patients. Unruh et al. [6] asked children to draw their pain. Thematic analysis revealed themes including actions and instruments causing pain, personification of the pain, physiological representation of the pain, perceptual disturbance associated with the pain, abstract representation of the pain, and location of the pain. The content of children's headache drawings can reliably differentiate migraine from non-migraine headaches, and changes in drawings over time reflect clinical improvements [7] and [8]. Children who have migraines tend to include sharp objects, while those with tension-type headaches include compression, and those with somatoform disorders sometimes include whirls in the head [9]. Chronic pain patients are often asked to draw the location of their pain onto provided outlines of the body, and these drawings can indicate unusual diseases or show changes in experienced pain over time [10]. Asking patients to draw more general pictures of how they experience their pain (without any outlines) may reveal additional information about the patients' perceptions. In this study, we aimed to investigate adults' perceptions of their headaches using drawings as an assessment method. We were interested in studying how features of the drawings were associated with individuals' illness perceptions, levels of pain, disability, and number of doctor visits. From our previous work, we hypothesized that bigger drawings would be associated with poorer illness perceptions and poorer physical and mental functioning.