Extreme sensitivity to light, throbbing pain, nausea and vomiting are just a few of the symptoms people with chronic migraines experience. In some cases, the symptoms linger for three days or longer, wreaking havoc on daily life. For others, they trigger a trip to the ER or, in extreme cases, hospitalization. Typically, physicians treat these debilitating headaches with anti-epileptics, antidepressants, muscle relaxants and blood pressure medications, with mixed results.

Steven Kosa, MD

Neurologist, Steven Kosa, MD

“Many chronic migraine patients are in a vicious cycle of daily analgesic use, which causes medication overuse/analgesic rebound headaches and worsens the migraines, making them very difficult to treat,” says Steven Kosa, MD, a neurologist with Meritas Health Neurology.

Botox, the popular injectable wrinkle reducer, is receiving attention as a viable treatment option, and according to Steven Kosa, MD, it can help stop the overuse of medication. “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.”

The Treatment

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

For maximum effectiveness, Dr. Kosa uses Botox is used in conjunction with the hospital’s physical therapy department, where therapists help patients relieve migraine symptoms of muscle stiffness, joint pain and involuntary muscles spasms in the legs and neck.

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.

Botox Treatment


Dr. Kosa is one of the region’s most experienced Botox doctors. He learned the procedure during his residency at Mayo Clinic. He began offering the treatment four years ago, after FDA approved Botox for migraine treatment.

Is Botox a Fit for You?

To determine if Botox could relieve your chronic migraines, call Meritas Health Neurology at 816.472.5157.