39, P < .0001), and moderate agreement between patient self-assignment via selection of representative pictures and patient self-assignment via answering the written question (Kappa coefficient 0.43, P < .0001). For exploding headaches, there was weak agreement between physician diagnosis according to scripted questionnaire and patient

self-assignment via selection of representative pictures (Kappa coefficient 0.33, P < .0001), weak agreement between physician diagnosis according to scripted questionnaire and patient self-assignment via answering the written question (Kappa coefficient 0.35, P < .0001), and weak agreement between patient self-assignment Torin 1 via selection of representative pictures and patient self-assignment via answering the written question (Kappa coefficient 0.39, P < .0001). For ocular headaches, there was moderate agreement see more between physician diagnosis according to scripted questionnaire and patient self-assignment via selection of representative pictures (Kappa coefficient 0.42, P < .0001), weak agreement between physician diagnosis according to scripted questionnaire and patient self-assignment via answering the written question (Kappa coefficient 0.37, P < .0001), and moderate agreement between patient self-assignment via selection of representative

pictures and patient self-assignment via answering the written question (Kappa coefficient 0.57, P < .0001). Responses to migraine therapies vary substantially among patients. For example, when measuring response to prophylactic therapy as at least a 50% reduction in headache frequency, less than one-half of patients treating with a first-line therapy are responders.[4] Identification of clinical factors that predict a patient's likelihood of responding to a specific migraine therapy would transition the treatment of migraine from a process of trial-and-error to a Adenosine triphosphate process of individualized medicine, maximize patient outcomes, and

minimize patient exposure to the potential adverse events from medications to which they are unlikely to respond. Published reports have suggested that migraine pain directionality is predictive of a response to onabotulinumtoxin A therapy. Studies have found an association between headache pain directionality and response to onabotulinumtoxin A[3, 5, 8] and more recently to botulinum toxin B.[7] Headache pain directionality has been described as imploding (a vice-like pain and pressure squeezing in), exploding (pain and pressure pushing outward), or ocular (pain focused on the eye).[3, 7] However, methods for determination of headache pain directionality have not been standardized. A number of different methods for determining headache pain directionality have been described.