Botulinum toxin type A applications for masticatory myofascial pain and trigeminal neuralgia: what is the evidence regarding adverse effects?

Clin Oral Investig. 2019 Sep;23(9):3411-3421. doi: 10.1007/s00784-019-03026-4. Epub 2019 Jul 24.


Objectives: The objective of the study was to conduct a systematic review of literature assessing botulinum toxin type A (BoNT-A) safety and adverse effects in the treatment of myofascial pain (MFP) and trigeminal neuralgia (TN).

Materials and methods: The search for articles by two specific researchers involved the PubMed, EMBASE, Web of Science, and Scopus databases. Specific terms were used, and no publication time and language restrictions were applied. Clinical trials that investigated the effects of BoNT-A among participants with myofascial pain in masticatory muscles or trigeminal neuralgia were considered eligible for this systematic review. Data for each study were extracted and analyzed according to a PICO-like structured reading.

Results: The search strategy provided 436 citations. After analysis, 16 citations were included, seven for MFP and nine for TN. In all studies, BoNT-A was well tolerated and improved pain. The most common adverse effects were temporary regional weakness, tenderness over the injection sites, and minor discomfort during chewing. Most studies reported a spontaneous resolution of adverse effect.

Conclusions: It can be concluded that BoNT-A treatment is well tolerated, since minor adverse effects were the most frequently reported; however, it is recommended that future studies aim to assess the safety and possible adverse effects of multiples applications or high doses of this treatment.

Clinical relevance: BoNT-A has been increasingly diffused in dentistry, being used for the management of masticatory myofascial pain and trigeminal neuralgia. Nonetheless, there is no consensus about its efficacy and adverse effects that could occur when this treatment is applied.

Keywords: Adverse effects; Bone loss; Botulinum toxins; Muscle atrophy; Muscle paralysis; Muscle weakness.

Publication types

  • Systematic Review

MeSH terms

  • Botulinum Toxins, Type A* / adverse effects
  • Humans
  • Mastication
  • Neuromuscular Agents* / adverse effects
  • Pain
  • Trigeminal Neuralgia* / drug therapy


  • Neuromuscular Agents
  • Botulinum Toxins, Type A