Botox is FDA-approved to treat cervical dystonia, a specific type of neck pain. While some doctors use it off-label to treat other conditions that cause neck pain, Botox does not appear to be effective in treating chronic neck pain.
Botox (botulinum toxin) is well known for its ability to smooth out wrinkles. Clinicians also use Botox to treat certain medical conditions, including some that cause neck pain.
Botox is not a cure for neck pain. Still, it may temporarily reduce the pain due to chronically contracted muscles.
Neck pain has many causes. The effectiveness of Botox in treating your neck pain will depend on the cause.
Chronic Neck Pain
The medical use of Botox to relieve chronic neck pain is widespread. However, the evidence for its effectiveness is mixed.
A 2017 review of studies found very high-level evidence that, in specific situations, Botox could effectively treat select causes of neck pain, such as cervical dystonia (discussed below). However, the same review found very high-level evidence that Botox was not effective in treating nonspecific chronic neck pain.
Botox is FDA-approved to treat cervical dystonia, a rare disorder that causes involuntary spasms and severe neck pain. It’s also known as spasmodic torticollis.
The involuntary and painful neck muscle contractions associated with cervical dystonia cause your head to twist uncontrollably to one side or tilt forward or backward. Botox releases or softens the contractions upon injection into the affected muscles, reducing symptoms.
Thoracic Outlet Syndrome
Thoracic outlet syndrome (TOS) is a condition that may result from:
- repetitive motion injuries
- sports injuries
- severe physical trauma from accidents
TOS causes the nerves or blood vessels between your collarbone and the first rib (thoracic outlet) to compress. TOC symptoms include:
- neck pain
- shoulder pain
- finger numbness
A 2021 review found several case studies supporting the use of Botox to treat pain resulting from TOC. It’s often the middle step in a treatment plan, following physical therapy and occurring before surgery.
Extreme, abrupt, back-and-forth head movement can cause whiplash, a common neck injury. It’s often the result of being rear-ended in a car accident or experiencing other types of head trauma.
Whiplash causes pain and severe strain on your neck muscles. A 2022 review found that Botox injections can reduce neck pain, muscle spasms, and headaches due to whiplash up to 12 weeks after treatment. Botox may also help improve the range of motion in your neck after whiplash.
Pinched Nerve (Cervical Radiculopathy)
Pinched nerve (radiculopathy) refers to a type of neuropathic pain. Neuropathic pain is a blanket term that refers to pain anywhere in the body caused by damage to the nervous system. Compression or pressure on nerve roots in the neck usually causes pinched nerves.
A 2020 review of studies found that Botox showed promise for treating neuropathic pain of various types.
Many people who experience migraine have neck pain in addition to other symptoms, such as severe head pain and nausea. Botox is FDA-approved to treat migraine.
Studies show that Botox can reduce the number of monthly headache days for people with chronic migraine. A clinician usually administers Botox to multiple injection sites along the face, head, and neck to provide temporary pain and symptom relief.
Botox comes from the C. botulinum bacterium. Too much of this toxin can be fatal. But in small, regulated amounts, Botox can stimulate nerve activity.
Botox works by interrupting the pathway of acetylcholine, a neurotransmitter. Acetylcholine transmits the perception of pain between your brain and spinal cord nerves. Blocking these pathways causes specific, targeted muscles to weaken, lose constriction, and become paralyzed.
To treat neck pain, a clinician will usually administer Botox via an injection directly into your neck muscles. The clinician will determine the appropriate dosage and injection site(s) to address your condition best. In many cases, you may need multiple injections.
The clinician will apply topical anesthesia to numb each injection site.
Typically, you should start to feel the effects of Botox injections within 2 to 4 weeks.
Clinicians use Botox to treat several conditions, including:
- multiple sclerosis
- TMJ (temporomandibular joint disorders)
- strabismus (crossed eyes)
- blepharospasm (eyelid twitching)
Botox can cause mild to serious side effects.
The most common side effects are:
- bruising at the injection site
Flu-like symptoms, including headaches and an upset stomach, may also occur.
Serious side effects are less common but may include:
- muscle weakness
- trouble swallowing or speaking
- trouble with vision
- loss of bladder control
- problems with breathing
Let a healthcare professional know immediately if you experience any serious symptoms.
Acute neck pain often resolves with at-home treatments. These include:
- over-the-counter pain medication
- application of heat or alternating heat with ice packs
- wearing a soft neck collar
Physical therapy can be highly effective at reducing neck pain. A physical therapist may guide you through exercises that strengthen the neck. They may also use transcutaneous electrical nerve stimulation (TENS) to reduce pain.
Severe, chronic neck pain, and neck pain that doesn’t respond to at-home treatments, may require prescription medications. These include muscle relaxers and strong nonsteroidal anti-inflammatory drugs (NSAIDs).
In some cases, a clinician may administer steroid medications to the painful area near the nerve roots.
In rare instances, you may require surgery to relieve cervical nerve compression.
Neck pain has a wide range of causes. You can treat some specific causes of neck pain, including cervical dystonia, with Botox injections. However, evidence suggests that Botox is ineffective at treating nonspecific chronic neck pain.
The effects of Botox are temporary, so it’s not a cure for neck pain. Still, it may effectively reduce pain and other symptoms for up to 12 months.
Precision Pain Care and Rehabilitation has two convenient locations in Richmond Hill – Queens, and New Hyde Park – Long Island. Call the Queens office at (718) 215-1888 or (516) 419-4480 for the Long Island office to arrange an appointment with our Interventional Pain Management Specialists, Dr. Jeffrey Chacko or Dr. Sonny Ahluwalia.