This was followed by a provider-administered survey regarding pain directionality. Survey questions were designed to allow the patient to express pain directionality utilizing simple written and pictorial representations of pain (Fig. 1). The design of the questions and diagrams were similar to those utilized by Jakubowski et al.[3] The survey classified migraine pain directionality as “exploding alone, imploding alone, ocular alone, or mixed (ie, combination of any 2 types or all 3 types).” Patients were given a paper survey with

the pictorial representations listed first followed by the written question, “Is your headache pain pushing in or pushing out of your head or is it located within your eye socket (ocular).” After the patient completed the written survey, the clinician conducted a scripted interview from which headache directionality, interattack variability in headache directionality and intra-attack variability in headache AZD6244 cost directionality were determined (Fig. 2). The clinician was blinded to the patient self-assignments of headache directionality. Summary statistics were used to describe selleck chemicals the study sample. Mean ± standard deviation was reported for continuous variables, and percentage/frequency count was computed for nominal variables. For comparison between groups, Kruskal–Wallis test and Pearson’s chi-square

test (or Fisher’s exact test, if applicable) were applied. If the overall test was significant, pairwise comparison was performed using Bonferroni adjustment. Using a 2-sided test, a P value < .05 for overall test was considered statistically significant. Kappa coefficients were calculated to determine concordance between the different methods of assigning headaches to 1 of 4 pain directionalities: imploding ± ocular, exploding ± ocular, ocular, or imploding and exploding. Kappa coefficients were considered

Smad inhibitor weak if less than 0.41, moderate if between 0.41 and 0.60, and strong if 0.61 or greater.[9] Analyses were conducted using SAS 9.2 (SAS Institute, Inc., Cary, NC, USA). One hundred ninety-eight female patients between the ages of 18 years and 77 years were included in the study. Mean age was 48 ± 12.4 years, and median age was 50 years. Race was self-reported as white by 88%, Asian/Pacific Islander by 4%, African American by 3%, and Other by 5%. Highest level of education was graduated college or higher by 65.5%, some college or technical school by 31%, graduated high school by 4%, and grade 11 or less by 1%. There were no differences in age, race, or highest level of education when comparing subjects with different headache directionality. Ninety-five percent (n = 188) of patients in the study reported episodic migraine (<45 headache days in 90), while 5% (n = 10) reported chronic migraine (>45 headache days in 90 days). According to patient selection of pictures that best represented their pain directionality, 14.