Fat injection is a relatively safe and effective adjunctive therapy in individuals suffering headaches that are refractory to medical therapy and surgical decompression, according to the findings of a newly published study in Plastic and Reconstructive Surgery.
In this prospective cohort study, the researchers evaluated 29 individuals who had migraine headaches with persistent symptoms after surgical decompression. They were given therapeutic fat injections from September 2012 to January 2015; the minimum follow-up was 12 months. The outcomes assessed were migraine frequency, intensity, and duration, as well as migraine headache index and complications. The sites of fat injections were frontal, supraorbital, zygomaticotemporal, greater occipital, auriculotemporal, or lesser occipital.
Therapeutic success was defined as a migraine decrease in frequency, intensity, or duration of 50% or higher. In contrast, worsening of symptoms was considered when the migraine headache index increased by 10% or higher. The researchers compared preinjection and postinjection symptoms using Wilcoxon signed rank tests with a two-tailed value of P <.05 to determine statistical significance.
All participants were women and had a mean age of 49.0 years (range, 21.5 to 72.5 years). Mean follow-up was 29.4 months (range, 12.3 to 49.5 months). A total of 37 sites were injected, with a mean of 1.28 sites injected per patient. The sites injected included 13 frontals (35.1%), 1 zygomaticotemporal (2.7%), 14 greater occipitals (37.8%), 8 auriculotemporal (21.6%), and 1 lesser occipital (2.7%).
A total of 20 participants (69%) experienced improvement, and 12 (41.4%) experienced complete resolution. Plus, 5 participants (17.2%) experienced subtherapeutic improvement, and 4 (13.8%) experienced worsening of symptoms. At their respective last follow-up, mean improvement per patient was 5.1 (39.3%) fewer attacks per month (P =.003); 3.1 (42.0%) lower intensity on a scale of 0 to 10 (P <.001); 31.8 (74.4%) fewer hours of duration per episode (P =.002); and 42.4 (52.8%) lower migraine headache index (P =.003). There were no major complications in any patient.
Some of the limitations found in this study are the small patient sample, which might increase type II error, the lack of a randomized controlled design, and the subjectivity of responses to the migraine questionnaire. Differences in reporting frequency and duration could have increased variance in the results.
The researchers concluded that fat injection is safer than methods like nerve stimulators and has similar efficacy. Therefore, fat injection could become the most reasonable alternative therapy for patients with migraines headaches that have failed medical management or surgical decompression.
Guyuron B, Pourtaheri N. Therapeutic role of fat injection in the treatment of recalcitrant migraine headaches. Plast Reconstr Surg. 2019;143(3):877-885.