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Botulinum Toxin Injections

Botulinum toxin introduced as a therapeutic medication in the late 1980s.  It revolutionized the treatment of dystonia by offering a localized method to relieve overactive muscle contractions.  Botulinum toxin is injected directly into specific muscles where it acts to relax those muscles and reduce excessive muscle contractions.

Botulinum is a biological product derived from the Clostridium botulinum bacterium.  It binds to the nerves that lead to the muscle and prevents the release of acetylcholine which is a neurotransmitter that activates muscle contractions.  When that messenger is blocked, muscle spasms are significantly reduced or eliminated.


Botulinum is not a cure. Conditions with overactive muscles such as cervical dystonia and blepharospasm often require long term treatment. The benefits of each treatment may begin within 3 days to 2 weeks depending on the condition.  The effects will usually last about 3 months.  Treatments can continue as long as the condition continues to respond and you don’t experience an allergic reaction or any significant side effects.

BOTOX® was recently approved by the FDA for the prophylaxis of chronic migraine. This includes those with 15 or more headache days per month lasting 4 hours a day or longer for at least 6 months.

Side Effects

The most frequent adverse reactions reported when using BOTOX® to treat cervical dystonia include dysphagia (trouble swallowing 19%), cold or flu (12%), neck pain (11%) and headache (11%).  When treating blepharospasm the most commonly reported adverse reactions were ptosis (droopy eyelids, 21%), inflammation of the cornea (6%) and dry eyes (6%). 
The most frequently reported adverse reactions following injection of BOTOX® for Chronic Migraine include neck pain (9%), headache (5%), eyelid ptosis (4%), migraine (4%), muscular weakness (4%), musculoskeletal stiffness (4%), bronchitis (3%), injection-site pain (3%), musculoskeletal pain (3%), myalgia (3%), facial paresis (2%), hypertension (2%), and muscle spasms (2%).

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