In this prospective study we report the results of EMG-guided BOTOX injections in a total of 15 cervical dystonia (CD) patients. Pre-treatment and post-treatment evaluations included physical examination results, Tsui ratings, and video recording. The dosage of BOTOX injection was determined by the EMG pattern, type of CD, and the degree of muscle hypertrophy. Seven patients underwent injections with and without EMG, and eight patients underwent injections with EMG-guidance only. The results showed that among the patients who underwent EMG-guided BOTOX injection there are: (1) fewer BOTOX-related side effects due to injection of the adequate dose of BOTOX to the accurate site of hyperactive muscles, (2) greater clinical improvement due to confirmation of hyperactivity in muscles in each type of cervical dystonia, (3) a better ability to reduce the amount of oral medication for treatment of muscle pain and spasms. We suggest that the use of EMG-guided BOTOX injections be considered for those CD patients with retrocollis, those who have had a sub-optimal treatment response to non EMG-guided BOTOX injections, and those with increased concern of side effects or a concomitant goal of reducing oral medications.