Bernhoff, Gabriella, Huhmar, Helena M, Rasmussen-Barr, Eva et al. · Journal of pain research · 2022 · DOI
This study looked at whether a simple drawing tool could help identify a specific type of headache (cervicogenic headache) in people with ME/CFS. Researchers found that 42% of ME/CFS patients had a particular pain pattern on their drawings that suggested their headache came from their neck. Patients with this neck-related pain pattern also experienced more dizziness, worse pain, and lower quality of life compared to others.
Headaches and dizziness are common but often poorly characterized in ME/CFS patients. This study provides a practical, non-invasive screening method that could help clinicians identify patients with cervicogenic headaches who may benefit from targeted neck-related treatments. Recognizing this specific headache subtype may improve symptom management and quality of life for affected patients.
This study does not prove that pain drawings can definitively diagnose cervicogenic headache—it only suggests they may be useful as a screening tool. The cross-sectional design cannot establish whether the C2 pain pattern causes the associated symptoms (dizziness, reduced quality of life) or merely correlates with them. The findings apply only to patients being evaluated for ME/CFS and may not generalize to other populations.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Bernhoff, Gabriella, Huhmar, Helena M, Rasmussen-Barr, Eva, & Bunketorp Käll, Lina (2022). The Significance of Pain Drawing as a Screening Tool for Cervicogenic Headache and Associated Symptoms in Chronic Fatigue.. Journal of pain research. https://doi.org/10.2147/JPR.S369470
BibTeX
@article{mecfsatlas-bernhoff-2022-significance-pain,
author = {Bernhoff, Gabriella and Huhmar, Helena M and Rasmussen-Barr, Eva and Bunketorp Käll, Lina},
title = {The Significance of Pain Drawing as a Screening Tool for Cervicogenic Headache and Associated Symptoms in Chronic Fatigue.},
journal = {Journal of pain research},
year = {2022},
doi = {10.2147/JPR.S369470},
note = {PubMed: 36061488},
url = {https://www.mecfsatlas.com/evidence/bernhoff-2022-significance-pain},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/bernhoff-2022-significance-pain
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