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Botulinum Toxin (Botox) Injections for Neurological Conditions

Small injections of botulinum toxin relax overactive muscles or reduce chronic migraine for about three months at a time, alongside physiotherapy and medicines.

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Botulinum Toxin (Botox) Injections for Neurological Conditions at Prakash Hospital, Neurosciences / Neurology
Session duration
15 to 30 minutes
Anaesthesia
Usually none needed
Results
Start within 1 to 2 weeks
Frequency
About every 3 months
On this page

Overview

Since the stroke, your hand has stayed curled into a fist, and opening it to wash the palm hurts. Or you've had a headache on more days than not for a year, and three preventive tablets haven't changed that. They're very different problems, but both can respond to the same treatment.

Botulinum toxin, widely known by the brand name Botox, is a purified protein injected in tiny doses into chosen muscles. It blocks the signal from nerve to muscle, so an overactive muscle relaxes. In chronic migraine it's thought to calm pain-signalling nerves in the head and neck. The effect wears off over about three months, so the injections are repeated.

The results are real but partial. Most people with dystonia or eyelid spasm get clear relief for most of each cycle. In chronic migraine it usually cuts the number of headache days rather than stopping them. After a stroke it loosens tight muscles, which eases pain and washing, but it doesn't bring back lost strength and works far better alongside physiotherapy.

Our neurology department regularly manages chronic migraine and movement disorders, and offers neurorehabilitation with our physiotherapy team. Your neurologist will tell you whether injections make sense for you.

Who it helps

It's used where particular muscles are overactive, and for chronic migraine that other prevention hasn't controlled.

  • Chronic migraine: headache on 15 or more days a month for at least 3 months, after two or three preventive medicines have failed
  • Spasticity (stiff, tight muscles) after a stroke or a brain or spinal cord injury, or in multiple sclerosis
  • Spasticity in children with cerebral palsy, such as tight calves causing toe-walking
  • Cervical dystonia, where neck muscles pull the head into a twisted position
  • Blepharospasm (eyelids squeezing shut) and hemifacial spasm (one side of the face twitching)
  • Writer's cramp and other dystonias of one hand or arm

Is it right for you?

Usually a good fit

  • A clear diagnosis and specific goals, such as fewer headache days or a hand that opens more easily
  • Symptoms that tablets haven't controlled
  • For spasticity, time to keep up stretching and physiotherapy afterwards

May not be suitable

  • Pregnancy or breastfeeding, where it's generally avoided
  • Myasthenia gravis or other disorders of the nerve-muscle junction
  • An infection at the injection sites, until it clears
  • Episodic migraine (under 15 headache days a month), where it hasn't been shown to help

Treatment options

For chronic migraine

About 31 small injections go into set points across the forehead, temples, back of the head, neck and shoulders, every 12 weeks.

For spasticity

Larger arm or leg muscles are injected, sometimes located with ultrasound or an EMG needle. Stretching, splints or casting afterwards make the most of the relaxed muscle.

For dystonia and facial spasm

Small doses go into the eyelid, face or neck muscles causing the movement, adjusted from one cycle to the next.

Before you start

  • Keep a headache diary for a month, or list the daily tasks that stiffness makes hard, so the effect can be measured
  • Tell your neurologist about blood thinners, which make bruising more likely
  • Mention pregnancy, breastfeeding or plans to conceive
  • Tell us about swallowing or breathing problems, and recent antibiotics such as gentamicin, which can strengthen the effect
  • Mention any botulinum toxin, including cosmetic, in the last 3 months
  • Check your insurance, since clinic injections may count as outpatient treatment

How treatment works

  1. 01

    Assessment and plan

    Your neurologist examines the muscles or reviews your headache diary, then decides where to inject and how much.

  2. 02

    Injections

    After the skin is cleaned, a very fine needle places small amounts into each muscle, with a brief sting each time. Ultrasound or EMG can guide the needle into deep muscles.

  3. 03

    Home the same day

    After a few minutes' rest you can go home or back to work.

  4. 04

    Review

    You're seen again at 4 to 6 weeks, when the effect peaks, and the plan is adjusted for the next cycle. Migraine treatment is judged after two cycles.

Benefits and risks

Benefits

  • Fewer headache days for many people with chronic migraine, and fewer painkillers
  • Relief from pulling, spasm or twitching in dystonia and facial spasm
  • Looser muscles that make washing, dressing and splinting easier after a stroke
  • Works only where it's injected, without the drowsiness of muscle-relaxing tablets

Possible risks

  • Pain or bruising at the injection sites for a day or two
  • Neck stiffness, or a drooping eyebrow or eyelid, after migraine injections in a few people
  • Too much weakness in the treated or nearby muscles, which wears off
  • Difficulty swallowing after neck injections for dystonia, usually mild and gone within 2 to 3 weeks
  • Rarely, the effect spreads and causes widespread weakness or trouble breathing or swallowing

After the injections

  1. 01

    The first day

    Carry on as normal, but don't rub or massage the injected areas.

  2. 02

    Weeks 1 to 6

    The effect starts within 1 to 2 weeks and peaks at around 4 to 6. For spasticity, this is when to push stretching and physiotherapy hardest. Migraine benefit can take longer.

  3. 03

    Around 3 months

    The effect fades and symptoms return. Doses are usually spaced at least 12 weeks apart, which lowers the chance of your body making antibodies against the toxin.

When to call your doctor

  • Difficulty swallowing, speaking or breathing. Get emergency help at once
  • Weakness spreading beyond the injected area, or double vision
  • Redness, swelling or pus at an injection site
  • A rash, facial swelling or wheezing after the injections

Call us on +91-8826000033 or come straight to our 24/7 emergency department.

Other options

Tablets and other injections for migraine

Preventive tablets such as amitriptyline, propranolol, topiramate or flunarizine are usually tried first. Monthly injections that block a migraine chemical called CGRP are another option.

Physiotherapy and tablets for spasticity

Stretching, splints and exercise are the base of treatment. Tablets such as baclofen or tizanidine suit widespread stiffness but often cause drowsiness.

Surgery in selected cases

Severe dystonia may be considered for deep brain stimulation at specialised centres. Hemifacial spasm caused by a blood vessel pressing on the facial nerve can sometimes be treated with an operation, which the neurosurgery team can advise on.

Talk to our Neurosciences / Neurology team

Ask about your options, the cost and your insurance before you decide. See the insurance and TPA panels we work with.

Book an Appointment+91-8826000033

This page explains Botulinum Toxin (Botox) Injections for Neurological Conditions in general terms. Your own plan depends on your health, your test results and your doctor's advice. Please read our medical disclaimer.

Your care team

Botulinum Toxin (Botox) Injections for Neurological Conditions is led by our Neurosciences / Neurology team, with other departments stepping in at each stage of your care.

Neurology Department
Leads your treatment

Neurology Department

At Prakash Hospital, our Neurology Department provides expert care for brain and nervous system disorders, offering accurate diagnoses and effective treatments to improve your neurological health.

What the department treats

Stroke Management

Epilepsy Care

Movement Disorder Treatment

Headache and Migraine Clinic

Nerve Conduction Studies

Dementia Care

Visit the Neurosciences / Neurology department

Other departments involved

Physiotherapy

Stretches and strengthens the treated muscles and fits splints, which makes injections for spasticity far more useful.

Visit department

Pediatric

Looks after children with cerebral palsy and plans their injections alongside therapy and growth.

Visit department

Ophthalmology

Checks for eye conditions such as dry eye that can mimic or worsen eyelid spasm.

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Meet the specialists

Related procedures

Procedures often considered alongside Botulinum Toxin (Botox) Injections for Neurological Conditions, or that treat related conditions.

Stroke Management

Round-the-clock emergency scans and treatment for stroke, followed by rehabilitation and prevention.

EMG / Nerve Conduction

Nerve and muscle tests that find the cause of numbness and weakness, such as neuropathy or carpal tunnel.

Dermatology & Cosmetic Surgery

Botox & Fillers

Anti-wrinkle injections and hyaluronic acid fillers that soften lines and restore facial volume, with no downtime.

EEG (Electroencephalogram)

Records the brain's electrical activity through scalp electrodes to help diagnose epilepsy and seizures.

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Frequently Asked Questions

Answers to common questions about Botulinum Toxin (Botox) Injections for Neurological Conditions at Prakash Hospital, Noida.

Is this the same as cosmetic Botox?

It's the same type of medicine, used differently. Cosmetic treatment smooths wrinkles with small doses in the face, while neurological treatment targets specific muscles or nerves, often with larger doses. For wrinkles, see Botox and fillers.

How long does each treatment last?

Usually about 3 months. Migraine injections are repeated every 12 weeks, and for spasticity or dystonia the timing is adjusted to how long the effect lasts for you.

Do the injections hurt?

Each one is a quick sting from a very fine needle. The migraine pattern of about 31 injections takes around 15 minutes, and children can have numbing cream first.

Will it cure my migraine?

No, it's a preventive. In studies it gave, on average, a couple more headache-free days a month than dummy injections, though some people improve far more and some don't respond at all.

Can children have this treatment?

Yes. It's widely used from about 2 years of age for spasticity in cerebral palsy, alongside physiotherapy and splints, with doses worked out by weight.

Is it safe during pregnancy?

It's usually avoided during pregnancy and breastfeeding because there isn't enough safety information. If you're planning a pregnancy, tell your neurologist so treatment can be timed around it.

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