Therapeutic Role of Fat Injection in the Treatment of Recalcitrant Migraine Headaches.

BACKGROUND

This study was designed to assess the safety and efficacy of site-specific fat injection for the treatment of refractory migraine headaches following medical or surgical treatment.

METHODS

A prospective cohort study was performed on consecutive patients who had migraine headaches with persistent symptoms after surgical decompression and were given therapeutic fat injections from September of 2012 to January of 2015 with 12 months' minimum follow-up. Clinical outcomes assessment included migraine frequency, intensity, duration, migraine headache index, and complications. A 50 percent or greater decrease in frequency, intensity, or duration was considered therapeutic success, whereas 10 percent or greater increase in migraine headache index was considered worsening of symptoms. Pairwise t tests were used to assess statistical significance (p < 0.05).

RESULTS

Twenty-nine patients met inclusion criteria. All were female, with a mean age of 49.0 years (range, 21.5 to 72.5 years), and mean follow-up was 29.4 months (range, 12.3 to 49.5 months). Twenty patients (69.0 percent) experienced successful improvement; 12 (41.4 percent) experienced complete resolution. Five patients (17.2 percent) experienced subtherapeutic improvement, and four (13.8 percent) experienced worsening of symptoms. Mean improvement per patient at their last follow-up was 5.1 (39.3 percent) fewer attacks per month (p = 0.035); 3.1 (42.0 percent) lower intensity on a scale of 1 to 10 (p = 0.001); 31.8 (74.4 percent) fewer hours of duration (p = 0.219); and 52.8 percent lower migraine headache index (p = 0.012). There were no complications for any patient.

CONCLUSIONS

Migraine headache symptoms were successfully reduced in the majority of cases with fat injection. A comprehensive surgical treatment algorithm including this novel procedure is presented.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.