Most people know Botox as a treatment that can smooth wrinkles and soften frown lines. But even though botulinum toxin injections are popular for slowing signs of aging, they aren’t just used for cosmetic reasons. They’re also used to treat some medical conditions that stem from tight, overactive or painful muscles.
Catherine Kapoor, MD, a neurologist with Banner Health, explained more about how Botox works and the health conditions it may help.
How Botox works
Botox is made from a purified protein produced by the bacteria Clostridium botulinum. When Botox is injected into specific muscles and used in small, controlled doses, it blocks the signals that tell your muscles to contract.
When muscles contract less, symptoms like pain, twitching or stiffness can get better. This means Botox and other brands of botulinum toxins, like Dysport, Xeomin and Myobloc, can be useful for many neurologic and muscular health conditions.
FDA-approved medical uses for Botox
FDA approval means that there’s research to support a treatment’s safety and effectiveness. The U.S. Food and Drug Administration (FDA) has approved Botox injections for several medical conditions, including:
- Chronic migraines: Botox can help reduce the number of headaches for people who have frequent migraines.
- Cervical dystonia: This condition causes the neck muscles to spasm or pull involuntarily. Botox can help relax these muscles and reduce pain.
- Certain muscle spasms and spasticity: Botox can reduce tightness in the arms or legs, including some cases linked to conditions like cerebral palsy, stroke and dystonia.
- Overactive bladder: Botox may help calm bladder muscle contractions so people with this condition don’t feel the need to urinate so often or so frequently.
- Drooling: Treatment may help control this condition.
Other conditions commonly treated with Botox
FDA-approved Botox injections may also work for some other health conditions, including:
- Blepharospasm (eye twitching), which was the first use for Botox injections
- Hemifacial spasm (facial twitching)
- Neck spasms caused by torticollis
- Stiff or tight muscles due to spasticity or dystonia, caused by neurological conditions such as stroke or cerebral palsy
- Excessive sweating
- Producing too much saliva
- Difficulty swallowing
- Essential tremor
- Certain eye conditions, such as strabismus (crossed or lazy eye) and ocular misalignment
“In these conditions, Botox helps relax muscles that contract too often or too forcefully,” Dr. Kapoor said. A health care provider can review symptoms and decide if Botox might be helpful.
Off-label uses of Botox
Health care providers may also use Botox off-label. “Off-label” means the treatment may be effective, based on clinical experience or research. But the FDA hasn’t approved it for that health condition.
Common off-label uses for Botox include:
- Jaw tension or symptoms related to temporomandibular joint (TMJ) disorders
- Pelvic floor muscle dysfunction that causes pain, tightness or sexual dysfunction
- Some types of neuropathic pain
- Excessive saliva caused by some neurologic conditions
“Off-label treatments can be helpful, but you should always talk to a trained provider, so you understand the risks and benefits for your situation,” Dr. Kapoor said. For off-label use, you need a medical review. Off-label use may not be right for everyone.
What to expect with Botox injections
Botox injections are usually done at a medical center or in a clinic. The procedure usually takes only a few minutes.
A provider uses a very small needle to place tiny amounts of Botox into the targeted muscles. You’ll need several injections, Your doctor can explain how many, depending on the health condition you’re treating.
You may notice:
- A quick pinching or stinging feeling
- Mild discomfort
- Temporary bruising at the injection site
- Small bumps at the injection site that go away in a few minutes.
“People typically can return home or to work right after the procedure. You should postpone a few activities, such as certain yoga positions or vigorous massage of the treated areas, for a while after treatment,” Dr. Kapoor said. Your provider can tell you when you can return to these activities.
It generally takes one to three days for the effects to start kicking in. The effects are not permanent. They last about three months, sometimes more, and then you’ll need a repeat round of injections.
Side effects and safety
Botox is safest when you get injections by a trained professional who understands how muscles move and how doses affect the area being treated.
Most side effects are mild and temporary. They may include:
- Redness or bruising at the injection site
- Mild bleeding
- Headache
- Flu-like symptoms
- Temporary muscle weakness near the area treated with Botox
“More serious reactions are rare,” Dr. Kapoor said. In these cases, the injections could cause slight or partial facial paralysis, eyelid drooping, crooked eyebrows or smile, drooling, dry eyes or excessive tearing.
It's rare but possible for the toxin to cause an allergic reaction or spread in your body and cause difficulty breathing or problems with vision, urination, speaking, swallowing or breathing.
If you develop these symptoms after injections, get medical care right away.
Is Botox covered by insurance?
You may have heard that insurance doesn’t pay for Botox injections. For cosmetic procedures, that’s usually true. But if you need injections for a health condition and your provider says they are medically necessary, insurance typically covers them.
It’s a good idea to contact your insurance provider and get any treatments preauthorized before you have them done.
Who should talk with a provider
If you have a condition that causes tight muscles, frequent muscle spasms or uncontrolled muscle contractions, you may want to talk to a health care provider to find out whether Botox might help. Your provider can help you figure out if Botox is the right choice for you.
Before being treated with Botox, talk to your provider about:
- Alternative pain relievers or muscle relaxants you can consider. You may want to try these less-invasive options first.
- The details of the procedure, such as how many injections you’ll need and how often they will need to be repeated.
- Any medications you use to relax your muscles, help you sleep or thin your blood, since they could cause interactions.
- Any other Botox injections you’ve had within the past four months.
- Using injections if you are pregnant or breastfeeding.
The bottom line
Botox isn’t just a treatment for facial lines and wrinkles. It can help treat a range of medical conditions, including chronic migraines, cervical dystonia and other muscle-related problems.
If you’re wondering whether Botox could help with your symptoms, a Banner Health provider can guide you through your options and help you understand the safest next steps.
