Cosmetic Surgery Tips

How Effective Is Botox For Cervical Dystonia

Botox is a drug that can be injected into the muscles of the face to treat wrinkles. But it can also be used in other ways, such as reducing muscle spasms in the neck, shoulders, or back.

Cervical dystonia is a chronic condition that causes involuntary muscle contractions in the head and neck. This can lead to pain, difficulty swallowing and breathing, and even difficulty speaking. Botox is sometimes used to treat cervical dystonia by reducing these muscle contractions.

In this post, you’ll read about botox for cervical dystonia side effects and cervical dystonia botox injections cost.

Botox (onabotulinumtoxinA) is a prescription brand-name medication. It’s approved by the Food and Drug Administration (FDA) to treat cervical dystonia in adults. This movement disorder causes involuntary muscle spasms in the neck. You may also hear it referred to as “spasmodic torticollis.”

Here are the basics on Botox:

  • Active ingredient: onabotulinumtoxinA
  • Drug class: neurotoxin
  • Drug form: liquid solution, given as an intramuscular injection to treat cervical dystonia
  • Available as generic: no

Botox For Cervical Dystonia Side Effects

The use of Botox for cervical dystonia* may cause mild or serious side effects. The lists below include some of the main side effects that may occur while using Botox for this purpose. To learn about other possible side effects of the drug, talk with your doctor or pharmacist. You can also see our comprehensive article on Botox or refer to Botox’s medication guide.

Note: The Food and Drug Administration (FDA) tracks and reviews side effects of drugs it has approved. If you would like to notify the FDA about a side effect you’ve had with Botox, you can do so through MedWatch.

* Botox is approved to treat other conditions as well. It’s important to note that side effects of Botox may differ depending on the condition it’s being used to treat.

Mild side effects

Like other medications, Botox injections can cause mild side effects. These side effects may be temporary, lasting a few days or weeks. But if they last for a longer time, or if they bother you or become severe, it’s important to talk with your doctor or pharmacist.

Mild side effects of Botox injections for cervical dystonia can include:

  • back pain
  • cough
  • dysphagia (trouble swallowing)
  • flu-like symptoms, such as fever, muscle pain, and nausea
  • headache
  • neck pain
  • rhinitis (inflammation in the nose)
  • upper respiratory infections, such as the common cold
  • muscle weakness or loss of strength
  • dizziness
  • vision problems

Note: After receiving Botox injections, watch for muscle weakness or loss of strength, dizziness, or vision problems. These side effects can occur hours, days, or weeks after receiving Botox treatment. If you experience them, you shouldn’t operate a car or machinery or participate in dangerous activities. Talk with your doctor so that they can evaluate your symptoms. They can also recommend other do’s and don’ts after receiving Botox.

Serious side effects

Rarely, Botox injections can cause serious side effects. Call your doctor right away if you develop serious side effects while using Botox. If the side effects seem life threatening or you think you’re having a medical emergency, call 911 or your local emergency number immediately.

Serious side effects from Botox injections can include:

  • allergic reaction
  • spread of toxin effects, which potentially could cause life threatening breathing or swallowing difficulties*

* Botox has a boxed warningTrusted Source for this side effect. For more information, see the section titled “Before receiving Botox” below.

Frequently asked questions

Here are some frequently asked questions about using Botox to treat cervical dystonia.

Can Botox make cervical dystonia worse?

It’s unlikely. In a clinical trial, worsening cervical dystonia wasn’t reported as a side effect.

However, between Botox injections, you may notice cervical dystonia symptoms coming back, especially the longer it is from your last dose.

In the trial, most people who received Botox injections reported that their cervical dystonia returned to “pretreatment” status about 3 months after their last dose. Botox treatment seemed to be most effective at easing symptoms of cervical dystonia 6 weeks after the injections were given.

If Botox injections don’t seem to be easing your cervical dystonia symptoms, talk with your doctor. They’ll help determine the best treatment for your condition.

If I use Botox for a long time, could it become less effective?

It’s possible. If you use Botox for a long time, your immune system might become so used to recognizing Botox that it develops antibodies to fight it. (Antibodies are blood proteins made in response to a specific substance and counteract it.)

As the antibodies learn to fight Botox, the drug may become less effective at easing your cervical dystonia symptoms. This means that you’re developing an immunity to Botox.

It isn’t clear why some people’s bodies create the antibodies, but receiving Botox more frequently or at higher doses than usual may be factors. Your doctor will try to reduce your risk for immunity to Botox. They’ll do this by prescribing the lowest dose to treat your symptoms and wait as long as possible between injections.

But if Botox injections don’t seem to be easing your symptoms of cervical dystonia, talk with your doctor. They can adjust your treatment plan as needed.

Using Botox

The Food and Drug Administration (FDA) has approved Botox to treat cervical dystonia.


The dosage of Botox for treating cervical dystonia will depend on:

  • the severity of your condition
  • the muscle or muscles affected
  • the level of pain you have due to your condition

Your doctor will determine the total amount of Botox that’s right for you. This will be divided into multiple injections for the affected muscle or muscles.

The average Botox dose for cervical dystonia in clinical studies was 236 units. Usually, your doctor will start you on a low dose, which they may increase, depending on how your body responds.

Note: In addition to treating cervical dystonia, Botox has other uses. Keep in mind that the drug’s dosage may differ with these other uses. To learn more, talk with your doctor.

How Botox is given

Botox comes as a liquid solution. To treat cervical dystonia, the drug is given as intramuscular injections into your neck muscles. Only a healthcare professional can give the injections, which you’ll receive during “treatment sessions.”

How often it’s given

Your doctor will advise you on how often you’ll need to receive Botox injections for your cervical dystonia. Based on the findings of clinical studies, they may start with injections every 3 months. They may then make adjustments based on any side effects you have and how well the drug eases your symptoms.

In a clinical study, people who received Botox for cervical dystonia noted that the effects seemed to wear off about 3 months after their previous dose. Botox treatment appeared to be most effective at relieving symptoms 6 weeks after the injections were given.

How well Botox works

A clinical study showed the effectiveness of Botox injections as a treatment for cervical dystonia.

People in this study received injections of either Botox or a placebo into the affected muscles. The researchers wanted to see if Botox was better than the placebo at improving people’s scores on the Cervical Dystonia Severity Scale. This is a 54-point scale on which a higher score indicates more severe problems with head position.

The researchers found that people who received Botox injections had more significant decreases in their scores than people who received placebo injections.

Guidelines from the American Academy of Neurology recommend Botox as a first-line treatment for cervical dystonia. This means that Botox would be the first treatment that a doctor would prescribe for the condition.

How Botox treats cervical dystonia

Botox is approved by the Food and Drug Administration (FDA) to treat cervical dystonia in adults.

The way Botox works

Botox is a type of drug called a neurotoxin. It works by stopping nerves from functioning.

Your nerves communicate with other parts of your body by using a neurotransmitter called acetylcholine. (Neurotransmitters are chemical messengers.) Botox works by preventing nerves from releasing acetylcholine. As a result, your nerves can’t send messages to muscles telling them to contract or spasm. With cervical dystonia, Botox prevents nerves from causing muscle contractions or spasms in your neck.

Over time, the effects of Botox injections wear off. This is because your nerves develop new endings that can begin releasing acetylcholine again.

How quickly does Botox work for cervical dystonia?

In a clinical study, people given Botox injections for cervical dystonia began noticing improvement in their condition within the first 2 weeks of receiving a dose. Botox seemed to be most effective at easing symptoms of cervical dystonia 6 weeks after the injections were given.

The list price for Botox is $1,244 for a 200 unit vial, but you will not normally pay this price. How much Botox costs you will depend upon your use and dose, your insurance type, and any additional fees charged by your healthcare provider for the procedure. Botox Cosmetic to lessen wrinkle appearance is usually not covered by insurance.

How much is Botox?

Commercial Insurance

On average, the out-of-pocket costs for Botox is $151 for people with commercial insurance they buy or is provided by their employer. If you have commercial insurance, you may be eligible for the Botox Copay Savings Program through the manufacturer. With this savings program, you may pay as little as $0 for your treatments. Most commercial insurance plans (99%) cover the majority of Botox costs.

To be eligible for the Savings program, you must be a resident of the U.S. or Puerto Rico. Copay assistance program is not available to patients receiving prescription reimbursement under any federal, state, or government-funded insurance programs. There may be annual savings limits on the dollar amount.


If you have Medicare or a Medicare Advantage plan, the average out-of-pocket Botox cost is $67 per 12-week treatment. Contact your specific Medicare Plan to learn more about your Botox coverage.


For people with a state-sponsored Medicaid plan, the average out-of-pocket cost is less than $200 per 12-week treatment. State plans can differ in their Botox cost. Contact your state Medicaid plan to learn more.

Cervical dystonia explained

Cervical dystonia is a movement disorder that causes involuntary muscle spasms in your neck. You may also hear it referred to as “spasmodic torticollis.”

The spasms create movements in your head and neck that can be repetitive and uncomfortable. This results in abnormal head positioning, which can cause pain in your neck.

Symptoms of cervical dystonia can include the neck twisting. Symptoms can also include the head and neck pulling backward, forward, or sideways.

The goal of Botox for cervical dystonia

The Food and Drug Administration (FDA) has approved Botox to treat cervical dystonia in adults. The goal of the treatment is to ease abnormal head positions and neck pain.

Before receiving Botox

Before you use Botox, there’s some important information to keep in mind. The drug may not be a safe option for you if you have certain medical conditions or other factors that affect your health. Some of these are mentioned below.

Boxed warning: Spread of toxin effects

Botox has a boxed warningTrusted Source. This is the most serious warning from the Food and Drug Administration (FDA). A boxed warning alerts doctors and patients about drug effects that may be dangerous.

On occasion, Botox may spread from where it’s injected to other parts of your body. This can result in botulism, a serious condition that may cause symptoms such as:

  • a lack of energy
  • difficulty breathing
  • difficulty speaking
  • difficulty swallowing
  • drooping eyelids
  • double vision
  • hoarse voice
  • loss of control over your bladder
  • muscle weakness

Botulism can occur hours, days, or weeks after a Botox injection. It’s important to talk with your doctor if you experience any of the symptoms mentioned above while using Botox.

In rare cases, the difficulty breathing or swallowing can be life threatening. People who already have trouble breathing or swallowing may be at higher risk of these problems.

Call your doctor right away if you experience problems with breathing or swallowing after a Botox injection. If you feel that your symptoms are life threatening, call 911 or your local emergency number.

Other warnings

In addition to boxed warnings, Botox has other warnings.

If any of the following medical conditions or other health factors are relevant to you, talk with your doctor before receiving Botox:

  • if you have a neuromuscular disorder, such as amyotrophic lateral sclerosis (ALS) or myasthenia gravis
  • if you have an infection in the area where you would receive Botox injections, such as the neck
  • if you have an upcoming surgery
  • if you’re pregnant or breastfeeding
  • if you’ve had an allergic reaction to Botox or any of its ingredients

Next steps

Now that you’ve learned about Botox for cervical dystonia, you may still have some questions. Talk with your doctor or pharmacist, who can advise you on whether Botox might be right for you.

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