Non-cosmetic Botox
Duration
15-45 minutes
Setting
Outpatient
Lasts for
6-9 months
Downtime
No downtime
Cost
400-600$ per treatment
Overview
Despite its wide usage for cosmetic treatment, Botox was also a successful treatment option for many medical conditions, especially those that failed on typical go-to treatment. If you have one of these conditions, then considering Botox injection is recommended.
Chronic Migraine
Candidates
- People who usually have headache attacks in one half of the head, and these attacks occur 15 days or more per month and more than 4 hours per day.
- They should try oral medication first and if they fail to 2-3 medications then they can be eligible to try Botox.
- All candidates should be at least 18 years old. Bendtsen, L., Sacco, S., Ashina, M., Mitsikostas, D., Ahmed, F., Pozo-Rosich, P., & Martelletti, P. (2018a). Guideline on the use of onabotulinumtoxinA in chronic migraine: A consensus statement from the European Headache Federation. The Journal of Headache and Pain, 19(1), 91. https://doi.org/10.1186/s10194-018-0921-8 Herd, C. P., Tomlinson, C. L., Rick, C., Scotton, W. J., Edwards, J., Ives, N., Clarke, C. E., & Sinclair, A. (2018). Botulinum toxins for the prevention of migraine in adults. Cochrane Database of Systematic Reviews, 2018(6). https://doi.org/10.1002/14651858.CD011616.pub2
Benefits
Botox can reduced frequency of migraine attacks. Patients had 2 fewer migraine attacks per month. Ahmed, F., Buture, A., Tanvir, T., & Khalil, M. (2021). Long term outcome for onabotulinumtoxinA (Botox) therapy in chronic migraine: A 2-year prospective follow-up audit of patients attending the Hull (UK) migraine clinic. Cephalalgia Reports, 4, 2515816320985443. https://doi.org/10.1177/2515816320985443 Herd, C. P., Tomlinson, C. L., Rick, C., Scotton, W. J., Edwards, J., Ives, N., Clarke, C. E., & Sinclair, A. (2018). Botulinum toxins for the prevention of migraine in adults. Cochrane Database of Systematic Reviews, 2018(6). https://doi.org/10.1002/14651858.CD011616.pub2
Injection site
A neurologist or a headache specialist will perform multiple injections in the scalp, temples, forehead, and neck. Bendtsen, L., Sacco, S., Ashina, M., Mitsikostas, D., Ahmed, F., Pozo-Rosich, P., & Martelletti, P. (2018a). Guideline on the use of onabotulinumtoxinA in chronic migraine: A consensus statement from the European Headache Federation. The Journal of Headache and Pain, 19(1), 91. https://doi.org/10.1186/s10194-018-0921-8
Complications
Patients might experience:
- Neck pain (4.3%)
- Injection site pain (2-1%)
- Eyelid drooping (1.9%)
- Muscular weakness (1.6%) like not being able to hold the head upright or there is mild shoulder droop. Corasaniti, M. T., Bagetta, G., Nicotera, P., Tarsitano, A., Tonin, P., Sandrini, G., Lawrence, G. W., & Scuteri, D. (2023). Safety of Onabotulinumtoxin A in Chronic Migraine: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Toxins, 15(5), 332. https://doi.org/10.3390/toxins15050332 Awan, K. H. (2017). The therapeutic usage of botulinum toxin (Botox) in non-cosmetic head and neck conditions – An evidence based review. Saudi Pharmaceutical Journal, 25(1), 18–24. https://doi.org/10.1016/j.jsps.2016.04.024 Escher, C. M., Paracka, L., Dressler, D., & Kollewe, K. (2017). Botulinum toxin in the management of chronic migraine: Clinical evidence and experience. Therapeutic Advances in Neurological Disorders, 10(2), 127–135. https://doi.org/10.1177/1756285616677005
Excessive Armpit Sweating
Candidates
People who are 18 years or older and have excessive armpit sweating that doesn’t improve with topical agents.
Benefits
Patients had reduced armpit sweating by 82-87%. Lowe, N., Naumann, M., & Eadie, N. (2023). Treatment of hyperhidrosis with Botox (onabotulinumtoxinA): Development, insights, and impact. Medicine, 102(S1), e32764. https://doi.org/10.1097/MD.0000000000032764 Sun, J., Chen, S., Yang, T., Huang, L., Tang, J., Feng, Y., Yu, Q., Wang, Y., Luo, Y., Tang, Y., & Gao, L. (2025). Efficacy and Safety of Botulinum Toxin Type A in Primary Axillary Hyperhidrosis: A Meta-analysis and Systematic Review. Aesthetic Plastic Surgery. https://doi.org/10.1007/s00266-025-04909-6
Injection site
A dermatologist or a plastic surgeon will do multiple injections across the armpits.
Complications
There are usually no complications, but some patient experienced mild swelling and bruising on the injection site. Sun, J., Chen, S., Yang, T., Huang, L., Tang, J., Feng, Y., Yu, Q., Wang, Y., Luo, Y., Tang, Y., & Gao, L. (2025). Efficacy and Safety of Botulinum Toxin Type A in Primary Axillary Hyperhidrosis: A Meta-analysis and Systematic Review. Aesthetic Plastic Surgery. https://doi.org/10.1007/s00266-025-04909-6
Neck Spasms
Candidates
This is useful for people suffering from neck spasm want to relieve muscle pain and correct the position of the neck. Candidates must be 16 years or older. Comparison and overview of currently available neurotoxins—PubMed. (n.d.). Retrieved June 14, 2025, from https://pubmed.ncbi.nlm.nih.gov/24587850/
Benefits
People experienced less pain and less muscle contractions after Botox injections.
Injection site
A neurologist usually injects Botox within the contracted muscles.
Complications
Some patients experienced muscle weakness as their head felt heavy and they had difficulty turning their head around (14%) some patients also had trouble swallowing (11%). Jinnah, H. A., Goodmann, E., Rosen, A. R., Evatt, M., Freeman, A., & Factor, S. (2016). Botulinum toxin treatment failures in cervical dystonia: Causes, management, and outcomes. Journal of Neurology, 263(6), 1188–1194. https://doi.org/10.1007/s00415-016-8136-x Rodrigues, F. B., Duarte, G. S., Marques, R. E., Castelão, M., Ferreira, J., Sampaio, C., Moore, A. P., & Costa, J. (2020). Botulinum toxin type A therapy for cervical dystonia. The Cochrane Database of Systematic Reviews, 11(11), CD003633. https://doi.org/10.1002/14651858.CD003633.pub4
Eyelid Spasms
Candidates
People 12 years or older who have eyelid twitching or eye asymmetry due to a difference in muscle power. This can impair vision and cause irritation.
Benefits
People experienced a smaller number of twitching and improved the severity of symptoms.
Injection site
A neuro-ophthalmologist will inject Botox around the eyelid.
Complications
Some patients experienced droopy eyelids (<10%) dry eyes (1-2%), and fear of light. Dashtipour, K., Chen, J. J., Frei, K., Nahab, F., & Tagliati, M. (2015). Systematic Literature Review of AbobotulinumtoxinA in Clinical Trials for Blepharospasm and Hemifacial Spasm. Tremor and Other Hyperkinetic Movements, 5(0). https://doi.org/10.5334/tohm.273 Duarte, G. S., Rodrigues, F. B., Marques, R. E., Castelão, M., Ferreira, J., Sampaio, C., Moore, A. P., & Costa, J. (2020). Botulinum toxin type A therapy for blepharospasm. Cochrane Database of Systematic Reviews, 2020(11). https://doi.org/10.1002/14651858.CD004900.pub3
Overactive Bladder
Candidates
Patients who have an overactive bladder, a condition that causes frequent urgency and need to urinate and doesn’t improve with medications.
Adults and children over 5 years can undergo Botox treatment for an overactive bladder. Padda, I. S., & Tadi, P. (2025). Botulinum Toxin. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK557387/
Benefits
Patient experience improved uncontrolled urination episodes by 3 less episodes per day.
63% of patients experienced uncontrolled urination before Botox, compared to 33% after treatment. Cox, L., & Cameron, A. P. (2014). OnabotulinumtoxinA for the treatment of overactive bladder. Research and Reports in Urology, 6, 79–89. https://doi.org/10.2147/RRU.S43125 Wefer, B., Ehlken, B., Bremer, J., Burgdörfer, H., Domurath, B., Hampel, C., Kutzenberger, J., Seif, C., Sievert, K. D., Berger, K., & Pannek, J. (2010). Treatment outcomes and resource use of patients with neurogenic detrusor overactivity receiving botulinum toxin A (BOTOX®) therapy in Germany. World Journal of Urology, 28(3), 385–390. https://doi.org/10.1007/s00345-009-0466-1
Injection site
A urologist will inject Botox within the bladder via a catheter.
Complications
Patients, especially those older than 65, experienced urinary tract infection (~18%) and urine retention (~6%). Overactive Bladder—Safety | BOTOX ONE® | BOTOX® (onabotulinumtoxinA). (n.d.). Retrieved August 24, 2025, from https://www.botoxone.com/oab/safety
Specific Considerations
Botox should be avoided in:
- Pregnant Women
- Actively breastfeeding women
- Neuromuscular disorders
- Taking muscle relaxants
- Active infection at the site of injection Satriyasa, B. K. (2019). Botulinum toxin (Botox) A for reducing the appearance of facial wrinkles: A literature review of clinical use and pharmacological aspect. Clinical, Cosmetic and Investigational Dermatology, Volume 12, 223–228. https://doi.org/10.2147/CCID.S202919
Botox Types
There are various types of Botulinum toxin, only four are approved for medical injections: Chen, S. (2012). Clinical Uses of Botulinum Neurotoxins: Current Indications, Limitations and Future Developments. Toxins, 4(10), 913–939. https://doi.org/10.3390/toxins4100913
Type A
It is the first go-to option. It is FDA-approved for all the previously discussed medical indications.
Type B
It is only FDA-approved for neck spasms. Used when patients fail to respond to Type A.
The effective dose varies according to the type of toxin. It is important to discuss with your physician your health condition to determine the most effective and safe dose for you. Bentivoglio, A. R., Del Grande, A., Petracca, M., Ialongo, T., & Ricciardi, L. (2015). Clinical differences between botulinum neurotoxin type A and B. Toxicon, 107, 77–84. https://doi.org/10.1016/j.toxicon.2015.08.001
Chapter references
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