Botulinum Toxin Injection Procedure

The botulinum toxin is injected with a needle directly into the overactive neck muscles. In order to do this, the doctor will have you sit in a chair in a relaxed position and will stand behind you.  Many doctors use an electromyograph (EMG), which is a machine that measures muscle activity, to select the muscles to be injected.  Others select the muscles by examining the abnormal head position and feeling for muscle spasm.  The botulinum toxin, which is packaged in a small vial, is diluted with a small amount of sterile salt water and put into a small syringe attached to a fine needle.  If the doctor uses the EMG to select muscles for injection, the needle used is one that can be attached to the machine to record the muscle activity and is hollow, allowing injection directly through the needle.  The needle is inserted into several muscles and the doctor watches and listens for the characteristic muscle activity.  This may appear on the screen or may be heard through an amplifier and speaker as a rumbling or thunder-like noise.  Sometimes, based on this activity, the doctor will choose not to inject botulinum toxin into the particular muscle, but rather to search for other more active muscles.  An entire treatment usually can be completed in less than 30 minutes.  You will be able to get up immediately after the injections and resume your normal activities.

If you have just been treated with botulinum toxin for the first time, you may be asked to return to the office two to four weeks following the initial injection in order to evaluate the outcome and side effects from the injections.  Some doctors may administer “booster” injections at the time of the follow-up visit if the response has been inadequate.

At the end of three to four months, if the toxin has begun to wear off and symptoms are returning, an appointment for another injection is usually made.