Botox Medical Migraine Dystonia Spasticity

Medical uses(Migraine, dystonia, spasticity) of Botox

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Botox Medical

About 50% of all Botox (Botulinum toxin) used world-wide is for cosmetic reasons (e.g. facial wrinkles). The other 50% is being used for medical reasons, many of which are covered by insurance. There are currently over 600 medical studies evaluating Botulinum toxin (see Some of these studies are for treatment of snoring, drooling, low back pain, arthritis, pelvic pain, Raynaud’s, bruxism, restless legs and depression.

Dr. Kuhlman may be able to get insurance to cover Botox for treatment of hyperhydrosis (excessive sweating of the arm pits, hands, feet), chronic pelvic pain (e.g. vaginismus, anal fissure, proctalgia, anismus), Raynaud’s (spasm of arteries in hands and feet cause pain and numbness, and fingers and toes turn red, white and blue with cold exposure), sialorrhea (excessive drooling) and bruxism (grinding  of teeth).  Botox for overactive bladder is FDA approved, but not performed by Dr.Kuhlman.

Botox for treatment of chronic migraine (FDA approved in 2010),Cervical dystonia ( FDA approved in 2000) and spasticity (FDA approved in 2010) are almost always covered by insurance.

Botox for Chronic Migraine


Migraine headaches are moderate to severe, often pulsating, last 2-72 hours and are worse with physical activity.  Associated symptoms include nausea and vomiting, and sensitivity to light, sound and smell. One third of migraine sufferers experience an aura.

In order for insurance to cover Botox for chronic migraine, the patient must have at least 15 headaches per month with half of these being migraine. They must have tried 3 types of preventative headache medications: an antidepressant (e.g. Cymbalta), an anticonvulsant (e.g. Neurontin) and a blood pressure pill (e.g Inderal), as well as abortive headache medications (e.g. Imitrex, Motrin).

Botox for chronic migraine involves using a very small 30g half-inch needle to inject 5 units of Botox into several muscles along the head and neck. The procedure only takes a few minutes. There is minimal discomfort and rarely a side effect. The goal is to reduce headaches by over 50% for 3 months and reduce the patient’s oral headache medications.

Botox for Cervical Dystonia


Cervical dystonia (AKA spasmodic torticollis) is a focal dystonia that causes the neck muscles to involuntarily contract, causing abnormal movements and awkward posture of the head and neck. Common features include head deviation, pulling sensation in the neck, neck pain, head tremor and shoulder elevation. It is usually better in the morning and worse with stress, fatigue and activity.

Botox for treatment of cervical dystonia consists of injecting the “tight” muscles of the neck and shoulder. EMG or ultrasound guidance is usually used to improve safety and accuracy. Side effects are rare other than occasional temporary weakness of the neck muscles. Botox is safer and more effective than oral medications. The treatment goal is to improve neck motion so the head looks straight, decrease tremor and decrease neck pain for 3 to 6 months.

Botox for Spasticity


Spasticity occurs after injury to the brain and spinal cord. Common conditions that cause spasticity include stroke, traumatic brain injury, multiple sclerosis, spinal cord injury and cerebral palsy The involved muscles become very tight and can contract so hard that the person develops joint contractures of the arm or leg.

Botox for treatment of spasticity consists of injecting the “tight” muscles of the arm and leg. EMG or ultrasound guidance is usually used to improve safety and accuracy. Side effects are rare other than occasional temporary weakness of the injected muscles.

When spasticity is localized to a specific area (e.g. foot turned down and in, clinched fist), Botox is usually the best treatment. When spasticity is present throughout the body, then oral medications and possibly a baclofen pump are used. For the best outcome, all spasticity patients must perform daily stretching of the tight muscles. Physical and occupational therapy and bracing the involved joints are frequently employed. Rarely, surgical release of the tight muscle is performed.


Botox treatment goals for spasticity include: decrease tone and improve range of motion, decrease pain, improve function/self care, improve appearance and decrease caregiver burden.

Please call Physical Medicine Associates at 419-228-5434 to schedule an appointment.

For more information on medical uses of Botox click here.

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