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.

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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.

Read on to learn more about Botox for neck pain.

Brand Names for botulinum toxin

Although Botox is the most well known, there are different types of botulinum toxin injections available:

  • onabotulinum toxin A (Botox)
  • abobotulinum toxin A (Dysport)
  • incobotulinum toxin A (Xeomin)
  • prabotulinum toxin A (Jeuveau)
  • rimabotulinum toxin B (Myobloc)

The different products are approved for different uses. You can consult with a healthcare professional to determine which is best for you.

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. But 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). But the same review found very high-level evidence that Botox was not effective in treating nonspecific chronic neck pain.

Cervical dystonia

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. Upon injection into the affected muscles, Botox releases or softens the contractions, 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.

Whiplash

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.

Migraine

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 best address your condition. 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:

How long do Botox injections for pain last?

Botox is not a cure for neck pain or any other condition. Over time, your body metabolizes the Botox and eliminates it from your body.

Botox injections provide symptom relief anywhere from 3 to 12 months, based on the condition you’re treating, the dosage you take, and the injection site.

Botox can cause mild to serious side effects.

The most common side effects are:

  • pain
  • swelling
  • 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
  • rest
  • 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.

Learn more about treatments for neck pain.

Is Botox FDA approved to treat neck pain?

Botox is FDA approved to treat cervical dystonia, a rare and specific cause of neck pain. Some doctors use Botox off-label to treat other forms of neck pain.

Does insurance cover Botox for neck pain?

Most insurance plans only cover procedures that they consider medically necessary. That’s why insurance does not cover Botox to treat wrinkles.

If Botox is FDA approved for your diagnosis, your insurer may cover some or all of its cost. A deductible or cap on coverage amount may apply. It’s important to check with your insurance provider to determine what type of coverage you can expect.

What is the difference between Botox Type A and Type B?

Two types of botulinum toxin are available for human use: Types A and B. While they both block the release of acetylcholine, they do this in slightly different ways.

Clinicians may also use rimabotulinum toxin type B (Myobloc) to treat cervical dystonia. Data indicates there is little to no difference in effectiveness between the two types.

Neck pain has a wide range of causes. You can treat some specific causes of neck pain, including cervical dystonia, with Botox injections. But 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 be effective at reducing pain and other symptoms for up to 12 months.