Skip to main content

Research Repository

Advanced Search

Images depicting headache pain – a tool to aid the diagnosis of cluster headache: a pilot study

Buture, Alina; Boland, Jason W.; Ahmed, Fayyaz; Dikomitis, Lisa


Alina Buture

Profile Image

Dr Jason Boland
Senior Clinical Lecturer and Honorary Consultant in Palliative Medicine

Fayyaz Ahmed

Lisa Dikomitis


Introduction and objective: The diagnosis of primary headaches is based on the International Classification of Headache Disorders (ICHD-3). Cluster headache (CH), a debilitating primary headache, is often misdiagnosed as migraine. In the absence of biological markers, a new visual screening tool with images depicting pain could aid the correct diagnosis of CH. The objective of the study is to test the tool on healthy participants and participants with CH and migraine.
Methods: In phase 1, 6 images portraying people with pain were tested on 150 healthy participants. The healthy participants were asked to rate the images as mild, moderate, severe or excruciating pain. In phase 2, the images were further tested on 116 participants with headache (16 participants with CH, 100 participants with migraine). The participants were recruited prospectively from a tertiary headache center between February and May 2017. The participants were asked to choose which image best illustrated their headache attacks.
Results: Phase 1 results showed that the images represent a range of headache pain severities from mild to excruciating as rated by healthy participants. They rated two images as excruciating, one image as severe, one image as moderate/severe, one image as moderate and one image as mild. Phase 2 results showed that two-thirds of participants with CH (69%) and half of the participants with migraine (52%) chose an image described as excruciating by the healthy participants.
Conclusion: We developed a screening tool with six drawings depicting headache pain severities from mild to excruciating as rated by the healthy participants. Although the images did not differentiate between CH and migraine, the study indicated the potential of using visual aids to assess headache severity.


Buture, A., Boland, J. W., Ahmed, F., & Dikomitis, L. (2019). Images depicting headache pain – a tool to aid the diagnosis of cluster headache: a pilot study. Journal of Multidisciplinary Healthcare, 12, 691-698.

Journal Article Type Article
Acceptance Date Jun 18, 2019
Publication Date Aug 22, 2019
Deposit Date Aug 30, 2019
Publicly Available Date Aug 30, 2019
Journal Journal of Multidisciplinary Healthcare
Print ISSN 1178-2390
Electronic ISSN 1178-2390
Publisher Dove Press
Peer Reviewed Peer Reviewed
Volume 12
Pages 691-698
Keywords General Nursing; General Medicine
Public URL
Publisher URL


Published article (4.3 Mb)

Copyright Statement
This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

You might also like

Downloadable Citations