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Headaches constitute an important part of the burden of neurological diseases. Migraine is one of the most important causes of disability among these headaches. In communitybased studies, chronic migraine (CM) was found at different rates. Studies have shown that CM costs are three to four times higher than the cost of episodic migraine. Poor clinical status of CM has been cited as the reason for these high costs. Migraine has an impact both on direct health costs and indirectly on labor costs as it causes labor loss. Studies have shown that CM also has negative effects on school and family life (1). Trigeminovascular system, which is comprising of sensory neurons arising from the trigeminal ganglion and the upper cervical dorsal roots, generates the migraine pathophysiology (2). Neurogenic inflammation is known to be most important parameter of migraine pain, and substance P, the calcitonin gene-associated peptide and neurokinin A are accepted to be vasoactive neuropeptides that released with stimulation of the trigeminal ganglion. In addition, neurogenic inflammation can lead to a sensitivity process. There is a continuous activation of the trigeminovascular system in patients with CM. Increased vasoactive neuropeptide levels in cerebrospinal fluid have been found to be associated with this condition (3,4). When the studies on the preventive treatment of CM are reviewed, there are important deficiencies regarding the study design. Because the study designs are heterogeneous, it is difficult to compare the results of similar studies and it leads to conflicting results in terms of treatment efficacy (5). CM is a headache that is difficult to treat. Analgesics, anti-epileptics, antidepressants, beta blockers, calcium channel blockers, greater occipital nerve blockade, Botulinum toxin applications and cognitive behavioral therapy are used in the treatment (6-9). In recent years, OnabotulinumtoxinA (BoNT-A) injections to the muscles in the head and neck region have been used in the treatment of CM (10,11). It has been understood that BoNTA is effective through different mechanisms. Due to its axonal DOI: 10.4274/gulhane.galenos.2020.928 ORIGINAL ARTICLE

Does the efficacy of different doses of Botulinum neurotoxin in chronic migraine change in terms of age and sex?