Botulinum toxin therapy
Targeted treatment for spasticity, cervical dystonia, and chronic migraine
Physician-led botulinum toxin therapy for selected neurologic and functional indications, guided by diagnosis, exam findings, safety screening, and clearly defined goals.
How it works
A precise tool when overactivity is part of the problem.
Botulinum toxin is a purified protein that can temporarily block acetylcholine release, the chemical signal that tells a muscle to contract. In small, targeted doses, this can create a controlled and reversible relaxation of overactive muscles.
At Wayfinder, botulinum toxin is evaluated through a PM&R lens: diagnosis, pattern recognition, functional goals, safety screening, and coordination with the rest of the recovery plan. The goal is not to inject every tight or painful area. It is to decide whether targeted treatment can support comfort, positioning, movement, therapy participation, or chronic migraine prevention.
Medical use
Medically directed botulinum toxin treatment for neurologic and functional indications.
Formulations
Available products include onabotulinumtoxinA (Botox), abobotulinumtoxinA (Dysport), incobotulinumtoxinA (Xeomin), and rimabotulinumtoxinB (Myobloc).
Minimalism in medicine
Judicious intervention and treatment is planned around its potential for functional gain.
Clinical indications
Common reasons botulinum toxin may be considered
Limb spasticity
Spasticity can follow stroke, spinal cord injury, traumatic brain injury, multiple sclerosis, and other brain or spinal cord conditions. Treatment may be considered when tone affects comfort, range of motion, gait, hand use, hygiene, dressing, bracing, or therapy progress.
Cervical dystonia
Cervical dystonia involves involuntary contraction of selected neck and shoulder muscles, which can cause head turning, tilting, pulling, stiffness, pain, or difficulty with daily activity.
Chronic migraine prevention
Chronic migraine generally means 15 or more headache days per month, with at least 8 migraine days, for 3 months or longer. Botulinum toxin is considered for chronic migraine prevention, not episodic migraine.
Guided targeting
For spasticity and cervical dystonia, target muscles may be selected using the clinical exam and, when appropriate, ultrasound, EMG, or electrical stimulation guidance.
Therapy window
When tone is reduced, therapy, stretching, splinting, orthotics, gait work, strengthening, or caregiver training may become more productive during the treatment window.
Follow-up refinement
Effects are temporary and response varies. Follow-up helps refine target muscles, dose, timing, therapy coordination, and the functional goals for future treatment.
Appropriateness depends on diagnosis, exam findings, treatment goals, medical history, and the clinician's safety screening.
Physician-led care
Careful evaluation before treatment.
Botulinum toxin therapy at Wayfinder is performed by Austin Johnston, DO, a board-certified Physical Medicine and Rehabilitation physician. Each plan starts with the clinical question and the reason treatment is being considered.
For spasticity or dystonia, the exam looks at which muscles are overactive, what movement or positioning problem they create, and whether injection fits the larger rehabilitation plan. For chronic migraine, the visit reviews headache pattern, prior treatments, safety considerations, and whether botulinum toxin belongs in the prevention strategy.
Review of diagnosis, goals, medications, and prior treatment response
Muscle or symptom targets selected from the clinical exam and guidance tools when appropriate
Coordination with therapy, bracing, or referring clinicians when needed
Follow-up to assess response and refine the plan
Visit flow
How the process usually works
Before the visit
Bring a medication list, including blood thinners and supplements. Tell the clinic about neuromuscular disorders, swallowing or breathing issues, prior injections, and, for migraine care, headache frequency.
Targeted procedure
If treatment is appropriate, injections are placed with a very fine needle. For tone or dystonia care, guidance may be used. For chronic migraine, treatment follows a standardized head and neck injection pattern.
Focused evaluation
The physician reviews the diagnosis, symptom pattern, prior treatments, medication considerations, safety factors, and the specific functional or headache-prevention goal.
Response and follow-up
Most patients return to normal activity afterward and avoid rubbing injection sites for 24 hours. Effects usually develop over days to weeks and are reassessed at follow-up.
Safety and screening
Useful treatment starts with careful patient selection.
Botulinum toxin injections are generally well tolerated, but they still require medical screening.
Tell the clinic
Share blood thinner use, medication changes, pregnancy questions, prior botulinum toxin response, swallowing or breathing problems, and neuromuscular diagnoses such as myasthenia gravis or Lambert-Eaton syndrome.
When treatment may wait
Botulinum toxin is not used when there is an active infection at the planned injection site, known allergy to the product or components, or a safety concern that requires a different plan.
Call for medical questions
Please call 406-607-6050 for clinical questions, referrals, appointment changes, and next steps. Website and email contact should not include protected health information.
For referring providers
Referral questions that need targeted tone, dystonia, or chronic migraine planning.
Wayfinder welcomes referrals when botulinum toxin therapy may clarify or advance a functional plan. Referrals may be placed for assistance with diagnosis, specific functional goals, injections or medication trials, therapy coordination, and bracing.
For spasticity, treatment planning is strongest when a specific functional problem is identified: gait, hand opening, hygiene, pain, positioning, splint tolerance, caregiver burden, therapy participation, or equipment fit. For chronic migraine, headache frequency, migraine-day pattern, and prior preventive treatment history are important factors when considering appropriateness for botulinum toxin therapy.
Referral reasons
Upper or lower limb spasticity after stroke, traumatic brain injury, spinal cord injury, multiple sclerosis, or other upper motor neuron conditions
Tone interfering with gait, hand function, hygiene, comfort, splinting, bracing, or therapy progress
Cervical dystonia with abnormal neck posture, muscle overactivity, pain, or functional limitation
Chronic migraine prevention questions when criteria and prior treatment history support consideration
Need for coordinated PM&R planning around injections, therapy, bracing, and functional goals
Helpful records
Diagnosis, clinical question, therapy notes, medication list, prior injection history if any, relevant imaging, and the specific functional goal.
Routing
Fax referral materials to 877-418-8011. For appointment changes, clinical routing, or time-sensitive questions, call 406-607-6050.
Clinical capabilities
How referrals are framed
Spasticity management
Goal-oriented planning for focal upper or lower limb spasticity, with target selection shaped by the neurologic diagnosis, exam pattern, therapy goals, bracing needs, hygiene, caregiver needs, and functional priorities.
Cervical dystonia
Assessment of dystonic patterns such as torticollis, laterocollis, retrocollis, and anterocollis, with treatment planning focused on the muscles driving posture, pain, and daily limitation.
Chronic migraine
Evaluation for chronic migraine prevention using established criteria and prior treatment history, with treatment planned around a standardized injection approach when appropriate.
For medical questions, referral routing, appointment changes, or next steps, please call the clinic rather than sending personal medical details through the website or email.
Patient questions
Common questions before scheduling.
-
Botulinum toxin therapy uses carefully targeted injections to temporarily reduce excessive muscle activity or support selected chronic migraine prevention plans when the diagnosis and safety screening make it appropriate.
-
No. This page describes medically directed botulinum toxin treatment for neurologic and functional indications, not cosmetic injections.
-
Wayfinder evaluates selected patients for limb spasticity, cervical dystonia, and chronic migraine prevention when clinically appropriate.
-
Usually no. For tone and functional problems, botulinum toxin is often most useful when paired with therapy, bracing, stretching, strengthening, gait work, or a broader PM&R plan.
-
Response varies. Many patients notice changes over days to weeks. Effects are temporary and treatment plans are reassessed over time rather than judged from a single injection visit.
-
Please call the clinic for medical questions, referrals, appointment changes, or next steps. Email and website contact should not include protected health information.
Next step
Ready to find the right route?
Call Wayfinder to discuss scheduling, referrals, or the best first step for your situation.