Axial truncal dystonia is characterized by an abnormal trunk posture often superimposed by myoclonic motor activities. Cervical dystonia is a motor syndrome characterized by abnormal head and neck posture due to tonic involuntary contractions in a certain set of muscles often superimposed by myoclonic or tremulous movements. Intramuscular injection of botulinum toxin is the first line treatment in cervical dystonia, in axial truncal dystonias botulinum toxin therapy is used only in mild forms. In this review the theoretical background, practical aspects and efficacy results especially in cervical dystonia are presented. Treatment of axial trunk dystonia is only briefly discussed at the beginning of this review.