Therapeutic Fat Injection: a Novel and Effective Treatment for Patients with Recalcitrant Migraine Headache Symptoms
Navid Pourtaheri, M.D., Ph.D, Bahman Guyuron, MD, FACS.
Case Western Reserve University School of Medicine, Cleveland, OH, USA.
PURPOSE: Migraine headache (MH) prevalence in the United States is 11.7%. There is no described surgical alternative for MH patients with symptoms that persist after medical management and surgical decompression. We designed a study to assess the effect of therapeutic fat injection on recalcitrant MH symptoms.
METHODS: After IRB approval, a prospective cohort study was performed on consecutive MH patients with persistent symptoms after surgical decompression who were given therapeutic fat injections from 9/2012 to 1/2015 with 12-months minimum follow-up. Clinical outcomes assessed included MH frequency, intensity, duration, MHI, and complications. A 50% or greater decrease in frequency, intensity, or duration was considered therapeutic success, while 10% or greater increase in MHI was considered worsening of symptoms. Pre- and post-injection symptoms were compared using pair-wise Student t-tests with p<0.05 for statistical significance.
RESULTS: Thirty-two patients were analyzed. Twenty-nine met inclusion criteria: 100% female with mean age of 49 years (range 21.5-72.5) and mean follow-up of 29.4 months (range 12.3-49.5). Twenty (69.0%) patients experienced therapeutic improvement (including twelve patients with complete resolution of symptoms), five patients (17.2%) experienced sub-therapeutic improvement, and four (13.8%) experienced worsening of symptoms. Compared to pre-operative symptoms, the mean improvement per patient at their last follow-up was: 5.1 (39.3%) fewer attacks per month (p=0.035), 3.1 (42.0%) lower intensity (p=0.001), 31.8 (74.4%) fewer hours of duration (p=0.219), and 52.8% lower MHI (p=0.012). There were no complications for any patient.
CONCLUSION: This study describes a novel adjunctive therapy for patients with recalcitrant MH that provides significant improvement in symptoms.
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