Visually, the Kaio-ken Kamehameha is almost identical to a standard Kamehameha. The only noticeable difference is that the energy wave is larger and much more powerful. As the Kaio-ken multiplier increases, the wave gets larger.
After being battered around by Goku's Kaio-ken x3 attack, Vegeta ends up losing his temper. The Saiyan prince then flies up in the air and launches his Galick Gun, intent on destroying Goku along with the Earth. Out of fear of letting the blast hit the Earth, Goku uses the Kaio-Ken x3 Kamehameha to repel the Galick Gun. Seeing how both attacks are evenly matched, Goku uses the Kaio-ken x4, surging through the Galick Gun and blasting Vegeta into the sky. However, Goku's body is left exhausted and weakened from having used so much power.
Goku uses the Kaio-ken x3 attack against Dr. Wheelo (which broke off one of Dr. Wheelo's claws) and then launches a Kaio-Ken x3 Kamehameha against the giant robotic scientist. After a brief Beam Struggle with Wheelo's Planet Geyser, Goku increases it to x4, allowing the blast to destroy Wheelo's lab fortress and send him into outer space.
During the fight with Frieza, Goku gets thrown underwater by the tyrant, who attempts to drown him. However, after seeing a vision of his friends and family being murdered and Earth destroyed, Goku regains courage and raises his Kaio-ken to x20, the highest Kaio-ken level. Goku then beats around Frieza and fires a gigantic Kaio-ken Kamehameha at the tyrant, who manages to block it, causing only slight damage to him. The blast was named x20 Kaiken Kamehameha in Dragon Ball Z: Budokai Tenkaichi 3.
Seeing as he was no match for Cooler in his final form, Goku uses the Kaio-ken Kamehameha against the tyrant. However, unlike his brother, Frieza, who was damaged by the attack, Cooler simply surges through the blast and attacks the surprised Goku.
- In Budokai Tenkaichi 3, the x20 Kaio-ken Kamehameha is spelled as "x20 Kaiken Kamehameha".