Not Just for Wrinkles: 20 Medical Conditions Treated with Botox

Chronic Migraine Management

One of the most well-established non-cosmetic uses of botulinum toxin (Botox) is for chronic migraine prevention. Approved by the FDA in 2010, Botox is indicated for patients who suffer from headaches on 15 or more days per month, with at least 8 being migraine days. The mechanism is not fully understood, but it is believed that Botox inhibits the release of neurotransmitters involved in pain signaling such as CGRP and glutamate.

The treatment involves injecting Botox into specific head and neck muscle groups, including the frontalis, temporalis, occipitalis, and cervical paraspinal muscle areas. It often requires about 31 injections distributed over 7 key muscle areas. Patients generally report reduced frequency, severity, and duration of migraine attacks over several cycles of injections.

Overactive Bladder and Urinary Incontinence

Botox has been approved for use in managing overactive bladder (OAB) and urinary incontinence due to neurogenic detrusor overactivity, particularly in conditions such as multiple sclerosis and spinal cord injury. Intradetrusor injections of Botox help relax the bladder muscle, thereby increasing bladder capacity and reducing urgency and frequency of urination.

The injections are administered under cystoscopic guidance, with the procedure typically done under local anesthesia. Results are noticeable within two weeks, and the therapeutic effect can last up to 6–9 months. While urinary retention is a potential side effect, clean intermittent catheterization (CIC) can be used as a management strategy.

Hyperhidrosis (Excessive Sweating)

For patients with severe primary axillary hyperhidrosis who are unresponsive to topical antiperspirants, Botox provides a highly effective solution. It works by blocking acetylcholine release at the neuromuscular junctions of eccrine sweat glands, thereby inhibiting sweat production.

Axillary, palmar, plantar, and even craniofacial hyperhidrosis have been treated with Botox. The treatment is localized, and results typically last between 4 to 12 months. Many patients report a substantial improvement in quality of life after Botox therapy.

Bruxism and Temporomandibular Joint Disorders (TMD)

Chronic teeth grinding and jaw clenching, often related to stress or misalignment, can lead to severe dental wear, jaw pain, and temporomandibular joint disorders. Botox has been used to relax the masseter and temporalis muscles to relieve pressure on the TMJ and decrease the intensity of grinding.

Dentists and orofacial pain specialists often administer 20–30 units per masseter, with dosage adjustments based on muscle hypertrophy. Patients often experience relief within a few days, and the effects can last 3–6 months. It also provides an aesthetic benefit by slimming the lower face in cases of masseteric hypertrophy.

Cervical Dystonia

Botox is FDA-approved for the treatment of cervical dystonia, a painful condition in which neck muscles contract involuntarily, causing abnormal head positions. It is considered the first-line treatment and significantly improves quality of life by reducing pain, abnormal posturing, and functional limitations.

The targeted muscles vary depending on the dystonic pattern but often include the sternocleidomastoid, trapezius, splenius capitis, and levator scapulae. Electromyographic (EMG) guidance is often used to improve injection accuracy.

Spasticity Management in Neurological Disorders

Botulinum toxin plays a crucial role in managing focal spasticity in patients with cerebral palsy, stroke, traumatic brain injury, multiple sclerosis, or spinal cord injury. By inhibiting acetylcholine release, Botox reduces involuntary muscle contractions and improves range of motion.

Dosing is highly individualized based on the severity, muscle group size, and patient goals. Commonly treated muscles include the gastrocnemius, hamstrings, adductors, biceps, and flexor carpi radialis. Combining Botox with physical therapy leads to optimal functional outcomes.

Strabismus and Blepharospasm

Botox has a long history in ophthalmology, having first gained FDA approval in 1989 for the treatment of strabismus and blepharospasm. In strabismus, Botox is injected into extraocular muscles to temporarily weaken an overacting muscle, allowing better ocular alignment.

For blepharospasm—characterized by involuntary contraction of the orbicularis oculi—Botox reduces spasm frequency and intensity, significantly improving visual function and social interactions. The injections are strategically placed in the eyelid and periorbital region, with repeat treatments typically needed every 3–4 months.

Sialorrhea (Excessive Salivation)

In conditions such as amyotrophic lateral sclerosis (ALS), Parkinson’s disease, and cerebral palsy, excessive salivation (sialorrhea) can lead to significant morbidity due to aspiration, perioral skin breakdown, and social embarrassment.

Botox injections into the parotid and submandibular glands under ultrasound or landmark guidance significantly reduce saliva production by blocking cholinergic innervation. Effects last about 3–6 months and can be repeated with minimal systemic absorption or side effects.

Depression and Psychiatric Disorders

Emerging evidence suggests that Botox may have a role in treating major depressive disorder (MDD). The proposed mechanism involves the facial feedback hypothesis: relaxing the glabellar muscles (corrugator and procerus) may interrupt the feedback loop between facial expression and mood regulation.

Small-scale trials have demonstrated promising antidepressant effects lasting several months after a single injection, though larger studies are still ongoing. This field represents an exciting frontier in psychodermatology and neuroaesthetics.

Chronic Anal Fissures

Botulinum toxin has been used in proctology to treat chronic anal fissures, particularly in patients unresponsive to topical therapies. The pathophysiology involves hypertonia of the internal anal sphincter, leading to decreased perfusion and impaired healing.

By injecting Botox directly into the internal anal sphincter, transient chemical denervation promotes muscle relaxation, improves blood flow, and facilitates fissure healing. This offers a less invasive alternative to lateral internal sphincterotomy, with fewer risks of incontinence.

Raynaud’s Phenomenon

In severe cases of Raynaud’s phenomenon—especially in patients with underlying connective tissue diseases—Botox has shown benefit in reducing digital vasospasm and associated pain. The proposed mechanism includes inhibition of sympathetic-mediated vasoconstriction.

Botox is injected in the periarterial region of the digital neurovascular bundles. Although not yet FDA-approved for this indication, off-label use has increased in rheumatology circles due to its promising effects in improving perfusion and reducing ulceration.

Esophageal Disorders: Achalasia and Dysphagia

Gastroenterologists have used Botox in the treatment of achalasia, a motility disorder characterized by impaired relaxation of the lower esophageal sphincter (LES). Botox injection into the LES under endoscopic guidance leads to temporary relief of dysphagia.

It’s typically considered when patients are unfit for pneumatic dilation or myotomy. While the therapeutic effect is transient (usually 3–6 months), repeat treatments can be done. It has also been trialed in other forms of esophageal spasm with varying success.

Vocal Cord Dysfunction and Spasmodic Dysphonia

Botulinum toxin has become a mainstay in the management of spasmodic dysphonia—a voice disorder marked by involuntary spasms of the laryngeal muscles during speech. Laryngologists inject Botox directly into the thyroarytenoid muscle or posterior cricoarytenoid, depending on the type (adductor or abductor) of dysphonia.

Patients often regain more natural voice control and improved speech fluency. However, careful dosing is critical, as overtreatment may lead to temporary breathiness or swallowing difficulty.

Scar Modulation in Surgery and Dermatology

Plastic surgeons and dermatologists have explored Botox to improve scar quality. By reducing muscular tension around healing incisions or wounds, Botox may help prevent hypertrophic scarring and keloid formation. This is especially valuable in facial surgeries where muscle movement contributes to scar widening.

Botox is often injected into the surrounding muscles immediately post-operatively, particularly in high-tension areas like the forehead, glabella, and chin. Preliminary studies have shown improved scar aesthetics with flatter, narrower, and less pigmented scars.

Facial Tics and Hemifacial Spasm

Neurologists use Botox to treat facial tics (such as those seen in Tourette syndrome) and hemifacial spasms. The goal is to reduce the intensity and frequency of involuntary facial muscle movements without causing weakness or disfigurement.

The muscles treated may include the orbicularis oculi, zygomaticus major, or platysma, depending on tic location. Careful dosing and targeting are key to avoid side effects such as eyelid ptosis or asymmetry.

Pain Management and Myofascial Pain Syndrome

Myofascial pain, characterized by trigger points and taut muscle bands, can significantly affect quality of life. Botox, when injected into active trigger points, has been found to reduce muscle contraction and interrupt the pain-spasm-pain cycle.

This approach is often used in refractory cases where conservative measures like physical therapy, dry needling, and NSAIDs fail. Areas commonly treated include the trapezius, levator scapulae, and piriformis.

Gastroparesis

Although still an off-label indication, Botox has been used to manage gastroparesis by injecting it into the pyloric sphincter to enhance gastric emptying. Endoscopic pyloromyotomy with Botox may reduce symptoms of nausea, vomiting, and early satiety in some patients.

Its use is particularly relevant in diabetic gastroparesis or postsurgical gastroparesis, where prokinetic agents have failed or caused side effects. Clinical trials have shown mixed results, so careful patient selection is essential.

Pseudoachalasia and Post-Surgical Sphincter Spasm

Botox is occasionally used in post-operative cases involving excessive sphincter tone—such as after anal, esophageal, or biliary surgeries. In these instances, temporary chemical denervation of the muscle helps reduce spasms and facilitates function during the recovery phase.

Psoriasis and Seborrheic Dermatitis (Experimental)

Recent pilot studies have explored the immunomodulatory effects of Botox in dermatology. Some findings suggest that intradermal injections may reduce sebaceous gland activity and modulate inflammatory cytokine expression in conditions like seborrheic dermatitis or psoriasis.

Though early in development, this represents a novel application of Botox beyond its neuromodulatory capabilities, expanding its role into the realm of immune and skin barrier regulation.