Botulinum toxin injections may help selected patients with chronic migraine, dystonia, muscle overactivity, TMJ pain, pelvic floor spasm, or hyperhidrosis.
Learn how Dr. Siefferman performs botulinum toxin (Botox) injections to treat chronic pain and movement disorders, helping patients reduce symptoms and improve function.
Our team organizes conditions and treatments into related zones of expertise to make it easier to explore the care paths most relevant to your symptoms and goals.
Use the zone tags above to browse dedicated pages for each focus area, including services, providers, and what to expect during treatment.
Hi, I’m Dr. Jason Siefferman, medical director at 91视频. We use botulinum toxin for a variety of purposes. It both desensitizes the nervous system and weakens muscles.
It’s especially useful for chronic migraine, orofacial dystonia, cervical dystonia, thoracic outlet, hyperhidrosis, spasticity, and focal dystonia. A key point is that botulinum toxin treatment is not a one-size-fits-all treatment with the exception of migraine. It’s important that we evaluate each patient to understand why the muscles are hyperactive and make sure there’s not an underlying driver for the muscle hyperactivity before we start applying the toxin.
Otherwise, there can be side effects. When we see patients, we really want to understand deeply what’s driving the muscle hyperactivity or nervous system sensitization before we start dosing botulinum toxin. When we do start treatment, the dosing is also very dependent on the level of muscle hyperactivity and hypertrophy. Botulinum toxin in general takes about three weeks to start working and then lasts about three months.
So for patients who do find it helpful, we generally end up repeating treatment every 84 days. It’s also worth noting that physical therapy is essential during this process unless it’s for nervous system desensitization. Anytime we’re weakening muscles, there’s always a rebalancing of the muscular forces and that must be paired with physical therapy.
Botulinum toxin injections are targeted medical injections that can temporarily reduce activity in selected muscles, glands, or nerve-muscle pathways. They may be considered for chronic migraine, cervical dystonia, focal dystonia, spasticity, TMJ-related muscle pain, pelvic floor muscle spasm, hyperhidrosis, piriformis-related pain, and certain complex pain patterns when clinically appropriate.
At 91视频, botulinum toxin injections are not treated as cosmetic Botox or a general pain solution. They are planned through a diagnosis-first process that considers symptoms, anatomy, exam findings, prior treatments, safety factors, dosing, and treatment goals.
MPM specialists evaluate whether botulinum toxin injections may be appropriate by identifying the diagnosis, the target area, and the clinical reason for treatment. This may involve reviewing headache frequency, muscle overactivity, dystonia, spasticity, TMJ-related muscle involvement, pelvic floor spasm, hyperhidrosis, or other nerve-muscle pain patterns.
The injection plan depends on more than the location of pain. It requires careful muscle selection, dose planning, safety review, and follow-up. Some uses are FDA-approved, while others may be off-label and require individualized discussion, realistic expectations, and coordinated care.
Jason W. Siefferman, MD
Medical Director | Interventional Pain Management | Headache Medicine
Luis Aranguren, MD
Interventional Pain Management
Tayyaba Ahmed, DO
Physical Medicine & Rehabilitation | Pelvic Pain
Adam Rosenberg, PA-C
Board-Certified Physician Assistant
Jordan Shankle, PA-C
Board-Certified Physician Assistant
Many patients search for Botox injections because the term is familiar, but medical botulinum toxin injections are different from cosmetic Botox. In pain medicine, the goal is not appearance. The goal is to target a specific medical pattern, such as chronic migraine, cervical dystonia, spasticity, muscle overactivity, TMJ-related jaw tension, pelvic floor spasm, or hyperhidrosis.
At MPM, botulinum toxin injections are considered only when the clinical picture supports them. For some conditions, such as chronic migraine, cervical dystonia, adult spasticity, and severe primary axillary hyperhidrosis, botulinum toxin has established medical uses. For other conditions, such as pelvic floor muscle spasm, TMJ dysfunction, piriformis-related pain, or certain complex pain patterns, use may be off-label and requires careful judgment. The medication is only one part of the procedure. Accurate diagnosis, target selection, dosing, and follow-up all matter.
Botulinum toxin injections may connect with several MPM Zones of Expertise, including Complex Chronic Pain, Headache, Pelvic Pain, and Musculoskeletal issues. In headache care, injections may be considered for chronic migraine when clinical criteria are met. In musculoskeletal care, they may be relevant when focal muscle overactivity, spasm, dystonia, or spasticity contributes to pain or restricted movement.
In pelvic pain, botulinum toxin injections may be considered selectively for pelvic floor muscle spasm or pelvic dystonia, often alongside pelvic floor therapy or other pelvic specialty care. For TMJ dysfunction, orofacial dystonia, cervical dystonia, thoracic outlet-related muscle overactivity, piriformis syndrome, hyperhidrosis, or complex pain, MPM evaluates whether the injection target is clear and whether treatment fits the patient鈥檚 broader diagnosis-first plan.
Before treatment, MPM reviews the diagnosis, target muscles or treatment areas, dose plan, expected timeline, possible side effects, and safety considerations. During the procedure, small amounts of botulinum toxin are injected into selected sites. Depending on the condition, injections may be planned using anatomical landmarks, imaging guidance, EMG guidance, or established treatment patterns.
Patients may feel brief pinching, pressure, or soreness during injections. Mild bruising, tenderness, or temporary weakness can occur afterward. The effect is not immediate and may take several days to begin. Benefit, if it occurs, is temporary and may last several months depending on the diagnosis, dose, treatment area, and individual response. Follow-up helps determine whether injections should be repeated, modified, or replaced with another treatment approach.
I cannot say enough good things about 91视频. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional 鈥� knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
The best care I've received as a chronic pain patient. I traveled from out of state to visit 91视频 because I could not find knowledgeable doctors in my hometown for my hypermobility, and Ehlers-Danlos syndrome symptoms and comorbidities. Let me tell you, it was worth every travel e...
I was injured in a bicycle accident over 8 years ago. I鈥檝e suffered throughout the years since my accident with nothing seeming to work. PT, Yoga, lifestyle changes, NOTHNG! I finally made an appointment with Dr Kane and I鈥檓 feeling an improvement in my life. I no longer stay up all night in pain, a...
One of the best experiences, if not the best, I have ever had at the doctor鈥檚 office. From the front desk to the nurses to the PA assisting the doctor this was a great experience. Dr.Nino actually listened to me and came up with a game plan. Would recommend this practice to as many people as I could...
I have very unique & severe nerve pain from CRPS which has no known specific cure. Dr. Siefferman has a huge tool box, far greater than the other 23 Drs. I have seen. He saved me from jumping off a bridge and continues to help me with both treatments and advice. Dr. S. is in a different league!
After two years of searching and feeling lost and let down, I finally found real help at 91视频. With Dr. Siefferman, Adam Rosenberg, Dr. Mikaberidze, and the whole team, I feel heard, supported and understood. Every symptom is being considered and I鈥檓 finally getting answers with m...
Why is Dr Dr. Tayyaba Ahmed one of the top pevic Floor specialists - 1- She wants to know a full history of what led the patient to get to this point. 2 - She listens intensley to the patient 3- She does not rush you 4- Extremely skilled at giving pelvic floor injections 5- I thank my luck stars she...
The staff was friendly and helpful. Dr. Siefferman was thoughtful, listened, asked questions and proposed simple safe ways to come to further conclusions regarding my pain and discomfort. The office staff including Dr. Siefferman is responsive even after the initial in-person visit. Very pleased.
Dr. Siefferman is a brilliant provider. While my pain is still a work in progress, Dr Siefferman always gives me options and explains his reasoning behind things. He listens to my feedback and concerns. I never feel rushed; and am grateful he works to meet me where I am. I highly recommend him.
What a great find! They listen to me, I listen to them and the diagnosis is made and a plan developed to develop an approach to treat all of my chronic pain. I wish I could have discovered this type of treatment sooner. This doctor and group give me hope.
Botulinum toxin injections are targeted medical injections that can temporarily reduce activity in selected muscles, glands, or nerve-muscle pathways. In pain care, they may be considered for chronic migraine, cervical dystonia, focal dystonia, spasticity, TMJ-related muscle pain, pelvic floor muscle spasm, hyperhidrosis, piriformis-related pain, or certain complex pain patterns. They are not a general pain cure and are not appropriate for every patient. MPM uses a diagnosis-first process to decide whether injections fit the condition, anatomy, safety profile, and treatment goals.
Botox is one brand name for a form of botulinum toxin. Many patients use the term Botox injections to describe botulinum toxin injections more broadly. In medical pain care, the treatment is different from cosmetic Botox. Medical Botox injections NYC care focuses on conditions such as chronic migraine, cervical dystonia, spasticity, hyperhidrosis, TMJ-related muscle overactivity, pelvic floor spasm, or other targeted pain patterns. The injection plan is based on diagnosis, anatomy, dosing, and clinical judgment.
Cosmetic Botox is generally used to reduce facial lines by relaxing selected facial muscles. Medical Botox is used to treat specific medical conditions, such as chronic migraine, cervical dystonia, spasticity, hyperhidrosis, or selected muscle overactivity patterns. In pain medicine, treatment planning focuses on symptoms, diagnosis, anatomy, function, safety, and treatment goals. MPM does not approach botulinum toxin injections as a cosmetic service. The goal is clinical care for selected patients, not appearance-based treatment.
Botulinum toxin injections may help pain when symptoms are linked to muscle overactivity, dystonia, spasm, chronic migraine pathways, or selected nerve-muscle patterns. The medication temporarily reduces signaling between nerves and targeted muscles or glands. This may reduce muscle contraction, spasms, headache frequency, or sweating in certain conditions. It does not treat every type of pain and does not correct all causes of symptoms. MPM evaluates whether the patient鈥檚 diagnosis and exam findings support this type of treatment.
Botulinum toxin injections may be used for chronic migraine, cervical dystonia, adult spasticity, and severe primary axillary hyperhidrosis in selected patients. They may also be considered off-label for certain cases of TMJ dysfunction, orofacial dystonia, pelvic floor muscle spasm, pelvic dystonia, piriformis-related pain, thoracic outlet-related muscle overactivity, or other focal muscle overactivity patterns. MPM determines whether treatment is appropriate based on diagnosis, target selection, prior treatments, safety factors, and realistic expectations.
Botulinum toxin injections may help selected adults with chronic migraine, commonly defined as frequent headache days, often 15 or more headache days per month. They are not generally used for occasional headaches or every migraine pattern. MPM evaluates headache type, frequency, associated symptoms, prior treatment response, and red flags before recommending Botox injections for chronic migraine NYC care. Injections may be part of a broader plan that includes medication management, trigger planning, procedures, or supportive therapies.
Botulinum toxin injections may be used for cervical dystonia when overactive neck muscles contribute to abnormal posture, spasms, pain, or limited movement. The injection sites are selected based on the specific muscle pattern and symptom presentation. Treatment does not cure dystonia, and the effect is temporary. MPM evaluates the diagnosis, involved muscles, neurological history, prior treatments, functional goals, and safety factors before considering Botox injections for neck spasms and cervical dystonia.
Botulinum toxin injections may be considered for selected patients with TMJ dysfunction when jaw muscle overactivity, clenching, spasm, or orofacial dystonia contributes to pain. They are not appropriate for every TMJ condition and do not replace dental evaluation, oral appliance therapy, physical therapy, medication management, or other TMJ care when needed. MPM evaluates jaw mechanics, facial muscle involvement, headache overlap, neck contributors, prior dental care, and safety factors before considering Botox injections for TMJ dysfunction and jaw pain.
Botulinum toxin injections may be considered off-label for selected patients with pelvic floor muscle spasm, pelvic dystonia, or pelvic pain patterns involving muscle overactivity. Evidence is mixed, and injections are not a universal treatment for pelvic pain. They do not replace pelvic floor therapy, gynecologic care, urologic care, nerve evaluation, or medical treatment when needed. MPM evaluates the pelvic pain pattern, muscle findings, prior treatment response, diagnosis, and safety factors before considering this option.
Botulinum toxin injections may help selected patients with spasticity when overactive muscles contribute to stiffness, abnormal positioning, pain, or functional limitation. They may also be used for severe primary axillary hyperhidrosis when appropriate. In both cases, treatment planning depends on diagnosis, severity, prior treatments, target selection, safety factors, and goals. Botulinum toxin does not cure the underlying cause of spasticity or all causes of sweating. MPM evaluates the clinical picture before recommending injections.
Injection sites are chosen based on the diagnosis, anatomy, exam findings, symptom pattern, treatment goals, and safety considerations. For chronic migraine, treatment may follow established injection patterns. For dystonia, spasticity, TMJ-related muscle pain, pelvic floor spasm, piriformis-related pain, or other conditions, injection planning may be more individualized. MPM may use anatomical landmarks, imaging guidance, EMG guidance, or condition-specific protocols depending on the target area and clinical need.
Botulinum toxin injections do not work immediately. Some patients begin to notice changes within several days, while the full effect may take longer depending on the condition, dose, target area, and individual response. Chronic migraine, dystonia, spasticity, TMJ-related muscle pain, pelvic floor spasm, and hyperhidrosis may each follow different timelines. MPM reviews expected timing before treatment and reassesses response to determine whether injections are helping.
Results are temporary. For many conditions, the effect of botulinum toxin injections may last several months, though duration varies by diagnosis, dose, injection site, muscle pattern, and patient response. Some patients experience shorter or longer benefit. If treatment helps, repeat injections may be considered at clinically appropriate intervals. MPM monitors how long benefit lasts, whether side effects occur, and whether the broader care plan should be adjusted.
Risks can include injection-site pain, bruising, bleeding, soreness, localized weakness, unintended muscle weakness, asymmetry, dry mouth, voice changes, swallowing or breathing difficulty, allergic reaction, spread of toxin effect, and condition-specific side effects. Risk depends on the treatment area, dose, medical history, and patient factors. MPM uses extra caution in patients with neuromuscular junction disorders, swallowing or breathing problems, active infection at the injection site, pregnancy or breastfeeding considerations, medication interactions, or prior reaction to botulinum toxin.
Repeat timing depends on the condition being treated, the patient鈥檚 response, side effects, duration of benefit, and medical guidelines. Many patients are reassessed after several months, but treatment should not be repeated too frequently without appropriate medical judgment. MPM reviews whether the injections helped, whether the dose or targets should change, whether side effects occurred, and whether other treatments should be added or prioritized before recommending another injection cycle.
Botulinum toxin injections may not be appropriate when the diagnosis is unclear, the treatment target does not match the symptoms, or safety risks outweigh potential benefit. They may need to be avoided or delayed with active infection at the injection site, certain neuromuscular conditions, significant swallowing or breathing problems, prior serious reaction, medication concerns, pregnancy or breastfeeding considerations, or unstable medical symptoms. Patients should seek urgent care for trouble breathing, trouble swallowing, severe allergic reaction, rapidly worsening weakness, new neurological deficits, chest pain, fever, or rapidly worsening symptoms.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
Botulinum toxin injections are targeted medical procedures used to temporarily reduce activity in selected muscles, glands, or nerve-muscle pathways. In pain medicine, they may be considered for chronic migraine, cervical dystonia, focal dystonia, spasticity, TMJ-related muscle pain, pelvic floor muscle spasm, piriformis-related pain, hyperhidrosis, and certain complex pain patterns.
At 91视频 (MPM), botulinum toxin injections NYC care is not approached as cosmetic Botox or a general pain treatment. The procedure begins with diagnosis. MPM evaluates whether the patient鈥檚 symptoms suggest a specific target, such as chronic migraine pathways, muscle overactivity, dystonia, spasticity, jaw muscle involvement, pelvic floor spasm, or excessive sweating.
Botulinum toxin temporarily reduces signaling between nerves and targeted muscles or glands. In muscle-related conditions, this may reduce overactivity, spasm, involuntary contraction, or tightness. In chronic migraine, the medication is injected according to a medical protocol and may help reduce headache frequency for eligible adults. In hyperhidrosis, it can reduce sweating in treated areas.
The treatment effect is not immediate. Some patients begin to notice changes after several days, while the full effect may take longer depending on the condition. Benefit, if it occurs, is temporary and commonly lasts several months. Follow-up is important because dose, target selection, and future treatment planning depend on how the patient responds.
The difference between medical Botox injections and cosmetic Botox is the purpose and planning. Cosmetic Botox is used to reduce facial lines by relaxing selected muscles. Medical botulinum toxin injections are used to treat diagnosed medical conditions or selected symptom patterns. The planning process considers diagnosis, anatomy, dose, function, risks, and clinical goals.
Some uses are FDA-approved, including chronic migraine prophylaxis in adults, cervical dystonia, adult spasticity, and severe primary axillary hyperhidrosis in selected patients. Other uses may be off-label, including certain cases of TMJ-related muscle pain, pelvic floor muscle spasm, piriformis syndrome, or orofacial dystonia. Off-label use does not automatically mean inappropriate, but it does require careful patient selection, informed discussion, and realistic expectations.
Botulinum toxin injections require more than identifying where pain is felt. Pain can be referred, layered, or driven by multiple systems. A patient with jaw pain may have TMJ dysfunction, orofacial dystonia, headache overlap, neck involvement, dental factors, or nerve sensitivity. A patient with pelvic pain may have pelvic floor muscle spasm, pudendal neuralgia, endometriosis-related pain, pelvic dystonia, PGAD, or centralized pain. A patient with neck tightness may have cervical dystonia, muscle guarding, nerve irritation, thoracic outlet syndrome, or spine-related pain.
MPM evaluates the full pattern before choosing injection sites. Depending on the condition, treatment may use anatomical landmarks, imaging guidance, EMG guidance, or established protocols. The goal is to inject the right target for the right reason, not to weaken muscles without a clear clinical purpose.
Botulinum toxin injections for chronic migraine NYC care may be considered when patients meet clinical criteria for chronic migraine. Botox injections for neck spasms and cervical dystonia may help selected patients with abnormal muscle contractions, spasms, and pain. Botox injections for TMJ dysfunction and jaw pain may be considered when jaw muscle overactivity is a major contributor. Botulinum toxin injections for pelvic floor muscle spasm may be considered selectively when overactive pelvic floor muscles contribute to pain, though evidence is mixed and many uses are off-label.
Injections may also be considered for spasticity, focal dystonia, orofacial dystonia, hyperhidrosis, piriformis-related pain, thoracic outlet-related muscle overactivity, and selected muscle overactivity patterns. They are not intended to cure fibromyalgia, central pain syndromes, post-viral pain, nerve pain, or complex chronic pain. In those cases, injections may only be relevant if there is a specific focal target.
Botulinum toxin injections can cause side effects. These may include injection-site pain, bruising, soreness, localized weakness, unintended muscle weakness, asymmetry, dry mouth, voice changes, swallowing or breathing difficulty, allergic reaction, spread of toxin effect, and condition-specific adverse effects. Risks vary depending on the injection area, dose, and patient health.
Extra caution is needed for patients with neuromuscular junction disorders, significant swallowing or breathing problems, active infection at the injection site, pregnancy or breastfeeding considerations, medication interactions, or prior reaction to botulinum toxin. Patients should seek urgent care for trouble breathing, trouble swallowing, severe allergic reaction, rapidly worsening weakness, new neurological deficits, sudden severe headache, chest pain, severe pelvic or abdominal pain, bowel or bladder dysfunction, fever, or rapidly worsening symptoms.
Botulinum toxin injections may be most useful when they are part of a broader plan. A patient with chronic migraine may still need headache management, medication review, trigger planning, or procedures. A patient with pelvic floor spasm may need pelvic floor therapy, pelvic specialty care, pain psychology, or nerve evaluation. A patient with TMJ dysfunction may need dental care, physical therapy, headache care, or medication management.
MPM reassesses response after treatment. If injections help, future treatment may be planned around duration of benefit, side effects, and functional goals. If they do not help enough, MPM may reconsider the diagnosis, adjust the targets, or recommend another pathway. The goal is precise, diagnosis-first care that uses botulinum toxin injections only when they fit the patient鈥檚 clinical picture.
