Botulinum toxin is a protein and neurotoxin produced by the bacteriumClostridium botulinum.  In December 1989, the United States Food and Drug Administration approved the use of BOTOX for:

  1. Strabismus (certain types of eye muscle problems) or Blepharospasm (involuntary forceful closure of the eyelids).  Since that time, other indications have been found including:
  1. Chronic Migraine– Adults with 15 or more migraine headaches a month lasting 4 or more hours each day
  1. Cervical Dystonia-Characterized by involuntary contractions of the neck muscles that cause twisting, repetitive movements or abnormal postures of the head.  These muscle contractions can cause severe, chronic neck pain.  The symptoms usually develop gradually over a period of time.  These muscle contractions can cause the head to move forward (anterocollis), backward (retrocollis), sideways (laterocollis) or to twist to either side (torticollis).
  1. Upper limb Spasticity – a condition that affects muscles in the arms resulting in stiffness and spasm.  This can be caused by stroke, Multiple Sclerosis, spinal cord injury, or brain injury.
  1. It is also used for treatment of overactive bladder, hyperhidrosis (excessive primary underarm sweating), and for cosmetic reasons to improve the look of wrinkles.

The effect of Botox is temporary and the treatment can be readministered approximately every three months.


Currently, there are no known absolute contraindications to the use of botulinum toxins other than being allergic to any of the ingredients of Botox. The relative contraindications include pregnancy, lactation, disorders of neuromuscular transmission (myasthenia gravis and Lambert-Eaton syndrome), motor neuron disease (i.e. ALS), and concurrent use of aminoglycosides (i.e. Gentamycin).

Side Effects

Side effects of botulinum toxin injections are mainly localized to the region injected. At the time of injection, patients may describe stinging.  Some of the side effects include: bruising at the site of injection, overweakening of the injected or surrounding musculature resulting in ptosis (droopy eyelids), difficulty swallowing, difficulty breathing, double vision, weakness of the muscles of the limb and change in speech.

Systemic side effects have also been reported. Some patients describe a flu-like syndrome with fever, chills, generalized weakness, and fatigue. These symptoms are all transient and may last up to a few weeks. It is not difficult to manage the side effects because they are all local phenomena. The only serious side effects are those that involve dysphagia (difficulty swallowing) or respiratory compromise when injecting the neck, mouth region, tongue, or larynx.