A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Response to prophylactic treatment of migraine with Onabotulinumtoxin A (BTX-A) has been noted to be significantly correlated to the perceived direction of headache pain, namely imploding vs. exploding subtype. This study analyzed 3 methods of assessing migraine directionality in comparison to a 30-day headache log; pictorial representation, written description, and physician assessment. Each of these assessment types was shown to have poor agreement with the headache log at the initial visit. However, all 3 assessments displayed excellent agreement at the return visit, as well as significantly improved confidence in patient ability to determine headache directionality.