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• W2313135453 abstract "Sir:FigureWe particularly appreciated the article entitled “Five-Year Outcome of Surgical Treatment of Migraine Headaches” by Drs. Guyuron, Kriegler, Davis, and Amini (Plast Reconstr Surg. 2011;127:603–608). We read with interest about different techniques used in treatment of migraine headaches. The authors discussed the role of surgery in the amelioration of this disabling condition and attempted to determine pathophysiologic reasons for the surgical success their patients have been enjoying, affirming that many questions are still unanswered. We agree with the consideration that an accurate identification of trigger sites is of critical importance, and we focused our attention particularly on reading about surgical techniques used by the authors for occipital trigger point. We would like to report our experience in treating chronic headaches related to occipital neuralgia and explain what, in our opinion, is the pathophysiologic reason for the success of our technique. Occipital neuralgia is frequently resistant to pharmacologic and surgical approaches. Often, important anatomical variations related to occipital neuralgia can be found, compromising the effectiveness of procedures such as surgical decompression or nerve block.1,2 Encouraged by our experience in using autologous fat graft in scar outcomes,3,4 we decided to use this technique in a case of severe unresponsive posttraumatic occipital neuralgia with cicatricial entrapment of the greater occipital nerve. Autologous fat graft, harvested from trochanteric areas and centrifuged at 3000 rpm for 3 minutes, was injected at the clinical trigger point (indicated by the patient with manual palpation) and the point of anatomical scar entrapment. The stable, long-term success of this procedure has been documented by asking the patient to indicate the pain level using a visual analogue scale (preoperative level, 8; 1-month postoperative level, 3), and by performing magnetic resonance imaging. Preoperative examination showed a thinning of subcutaneous adipose tissue and the presence of cicatricial fibrous tissue, whereas examination at 3 months postoperatively showed restored appearance of subcutaneous adipose tissue in the treated area. Considering the results obtained, we used this technique in other cases of occipital neuralgia not related to posttraumatic scars, and always obtained a reduction of frequency, duration, and intensity of headache episodes. We are now conducting an important clinical study with long-term follow-up in all treated patients. Our hypothesis is that, in many cases of chronic headache related to occipital neuralgia, a pathologic thinning of the subcutaneous fat layer in this area is involved, making possible the contact between occipital nerves and other anatomical structures—such as occipital arteries—and thus conditioning development of pain. The autologous fat graft procedure allows the subcutaneous adipose tissue layer to be thickened, possibly acting as a “decompression neurolysis.” Furthermore, as shown in our other studies,3–5 adipose tissue has regenerative properties and, first of all, an analgesic effect. The biological reasons of these properties are still unclear but appear to be related to the therapeutic success we achieve in treatment of chronic headaches. Considering also the simplicity of the procedure, the absence of residual scars, and the virtual lack of complications, we believe that autologous fat graft is an excellent option for the treatment of migraine headaches. Fabio Caviggioli, M.D. Università degli Studi di Milano, U.O. Chirurgia Plastica, IRCCS Multimedica Group Milano, Sesto San Giovanni, Milan, Italy Silvia Giannasi, M.D. Valeriano Vinci, M.D. Guido Cornegliani, M.D. Università degli Studi di Milano, U.O. Chirurgia Plastica 2, IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy Daniel Levi, M.D. Paolo Gaetani, M.D. Università degli Studi di Milano, U.O. Neurochirurgia, IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy" @default.
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• W2313135453 date "2011-11-01" @default.
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• W2313135453 title "Five-Year Outcome of Surgical Treatment of Migraine Headaches" @default.
• W2313135453 doi "https://doi.org/10.1097/prs.0b013e31822b632a" @default.
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