Trigger Point Injections with Botox (Botulinum Toxin A) for the Treatment of Neck Pain


Cervical Trigger Points

A trigger point is the specific area in the muscle that produces pain, or ‘triggers’ it. They are also commonly referred to as ‘knots’ in the muscle and are usually caused by an injury or a degenerative condition. Most types of pain and stiffness in the neck muscles occur in two muscle groups: The Levator Scapulae and the Trapezius. 

The Levator Scapulae muscle is a long and thin muscle located on each side of the neck. It is attached to the upper spinal vertebrae and runs twisting downwards to attach to the upper end of the shoulder blade. It contracts to raise the shoulder blade (shrugging the shoulders) and helps to rotate the head at the same time. These muscles are often overloaded by bad posture, sporting injuries and whiplash injuries. The Levator Scapulae trigger points reduce head turning capability, forcing the person to turn their body instead, with tension in the muscles also causing a shortness of breath.

The Trapezius is the large, diamond shaped muscle group that forms the base of the neck and upper back region. It attaches to the base of the skull, along the spine, on the shoulder blade and on the collar bone. It typically moves the shoulder blade, but also helps to move the neck and head. Trigger points in the muscle group refer to pain to the back and side of the neck, the temple region, behind the ear or back of the head, the shoulder joint and in the upper back. Poor posture, emotional distress, whiplash injuries, falls and bad sleeping positions can all develop trigger points in the Trapezius muscle group.


Botox (Botulinum Toxin A)

Patients that have easily identifiable trigger points, permanently contracted muscles, or headaches that are associated with muscle spasms are very good candidates for Botulinum Toxin A injections. Botox is the industry name for Botulinum toxin type A, which is derived from a strain of bacteria called clostridium botulinum. When Botox is injected into a muscle, it blocks the signals sent from the brain which tell the muscle to contract. Botox targets the muscles involved by effectively disarming them and ensuring that they do not send panic signals throughout the body. The body believes that there is no pain being experienced. Botox can help to keep the muscle relaxed for anywhere from three to six months, after which it is hoped that the muscle will be able to contract normally without pain or spasms.



Botox injections are performed as an outpatient procedure at the London Pain Clinic, with patients free to leave as soon as the treatment has been administered. Initially, the treating doctor will spend time identifying the individual trigger points, sometimes with the help of a physiotherapist, and will mark the areas with a pen. The located areas will then be sterilised with a chlorhexidine antiseptic spray and a fast acting local anaesthetic will be will injected through a small cosmetic needle.

The Botox can then be administered by one of three different ways, depending on the case. Usually, small cosmetic needles are preferred, but a Stimuplex nerve stimulator or ultrasound guidance are sometimes necessary if the trigger points are more difficult to access. 100 units of Botox are usually administered, but this can increase up to 200 units depending on the affected area.


Procedure Outcomes

One of the major advantages of Botox is that there is little or no recovery time, and most people feel fine and can return to their normal life immediately. The results of treatment should last around 3-6 months and the procedure can be repeated after this time.