Minimally Invasive, Micro-Autologous Fat Transfer for Secondary Occipital Neuralgia

To evaluate the role of Autologous Fat Transfer (AFT) for secondary occipital neuralgia (SON).

Secondary occipital neuralgia manifests as neuropathic pain developing after traumatic tissue injury. Multidisciplinary management mainly relies on analgesic medications and local anesthetic and steroid infiltrations. Autologous fat transfer restores subcutaneous tissue, mechanically releasing scar from nerve fibers. In this study, we show the therapeutic uses of AFT for secondary, drug-resistant headaches.

In this retrospective study, 19 patients with secondary occipital neuralgia associated with occipital scalp scarring were included. All patients presented with symptoms of unremitting greater or lesser occipital neuralgia, which temporarily improved (> 50% temporary reduction in pain intensity) following local anesthesia infiltration of the scar. Patients' evaluation of pain by visual analog scale (VAS), number of acute spasmodic pain events and medication intake per month were assessed before and 12 months after AFT. Evolution of tactile detection thresholds and allodynia patches was determined by Weinstein monofilaments.

A comprehensive clinical follow-up was made 12 months after AFT. Eighteen patients experienced a reduction of symptoms > 50%. Ten of these were pain-free. The pain level reduced from 8.7 to 3. A reduction of 85% of acute pain events per month was noted after surgery (from 23.6 to 4.6). Finally, a 74% reduction in medication intake was also seen. No complications were observed.

AFT is a novel, regenerative approach for secondary occipital neuralgia. While more studies are needed to better understand the mechanisms of action, the results from this minimally invasive technique should be regarded as an important asset in regenerative medicine for treating post-traumatic headaches.