Botox® Revolutionizes Migraine Treatment

Botox® provides a new modality for treatment of chronic migraines that "works very well for a lot of patients" says Steven Kosa, MD, with Meritas Health Neurology. "Treating patients with chronic migraines, defined as 15 headaches per month for 3 months or longer, has been very frustrating for many physicians, including both primary care physicians and neurologists," says Dr. Kosa. "Until Botox, there was not a consistently effective treatment. Botox injections have revolutionized the treatment of these patients and can change the lives of this large and struggling patient population."


BotoxThe Botox treatment protocol consists of 31 injections into cranial and neck muscles. The procedure, which takes less than 5 minutes and uses a small 30-gauge needle, delivers Botox to the front, sides and back of the head and into the upper cervical paraspinal and trapezius muscles. Most patients receive the treatments every 12 weeks, but some can go for longer periods between the injections.

Effectively treated migraines help patients avoid ER visits and hospitalizations. They not only regain normalcy in their lives, but they are more productive and miss fewer days of work.


Dr. Kosa is one of the most experienced Botox injectors for chronic migraines in the region. He learned this technique while training at Mayo Clinic during his residency, and began offering the treatment at his practice four years ago, after FDA approved of the medication for this indication.

Before & After

Previously, chronic migraines were treated with a variety of medications with mixed results. Most patients tried anti-epileptics, antidepressants, muscle relaxants, blood pressure medications and other typical prophylactic medications with varying results and side effects.

"Many chronic migraine patients are in a vicious cycle of daily analgesic use, causing medication overuse/analgesic rebound headaches which worsen the chronic migraine and make it very difficult to treat."

                      Steven Kosa, MD

"Many chronic migraine patients are in a vicious cycle of daily analgesic use, causing medication overuse/analgesic rebound headaches which worsen the chronic migraine and make it very difficult to treat," Dr. Kosa says. "The cycle can be broken with the administration of Botox and cessation of the overused medications, which can truly positively change the patient’s life."


Migraine patients are advised to see a neurologist so they can receive a comprehensive headache and migraine evaluation along with a full neurological examination and testing, including a full history as deemed appropriate.


The history of Botox for medicinal uses started in ophthalmology. Physicians used it to control eye movement abnormalities in the 1970s. Botox was explored for a range of conditions and eventually research trials began for use in migraine treatment. The current Botox protocol took approximately a decade to perfect. Many injection paradigms were tested until the 31-injection sites proved the most beneficial.

Other Uses

Botox is proving useful for other conditions including:

  • Botox is used to target and relax the overactive muscles. Often electrical stimulation and electromyographic localization is used to appropriately deliver the Botox.
  • Spinal cord injury associated spasticity.
  • Cerebral palsy associated spasticity.
  • Cervical dystonia or torticollis – Overactive muscles are identified, weakened and relaxed with Botox injections using eletromyographic guidance in most cases.

Physical Therapy

For maximum effectiveness, Botox is used in conjunction with physical therapy. Dr. Kosa refers his patients to the North Kansas City Hospital’s physical therapy department, which works with patients to relieve symptoms of spasticity and cervical dystonia.

Baclofen Pump

For patients whose spacisticy is too extreme for Botox injections alone, Dr. Kosa offers a baclofen pump option. The pump is surgically implanted in the adipose tissue of the abdominal wall, and feeds a steady dose of baclofen into the spinal fluid. After the surgical implantation, Dr. Kosa uses a telemetry device to establish proper dosing. Optimal treatment of the symptoms of spasticity involves the baclofen pump, targeted Botox injections and physical therapy.

To learn more, call 816.472.5157.

Steven Kosa, MD

Steven KosaDr. Kosa received his medical training at the University of Kansas School of Medicine. He completed an internal medicine internship at Kansas University Medical Center and his neurology residency at Mayo Clinic, MN. His areas of interest include treatment of neuromuscular and peripheral nerve disorders, electromyography, headache treatment and spasticity management.