Stem Cells in the Treatment of Refractory Chronic Migraines

BACKGROUND Autologous adipose-derived stromal vascular fraction (SVF), which is rich in mesenchymal stromal cells, has been reported to be effective for the treatment of trigeminal neuropathic pain and chronic migraine and tension-type headaches. It is possible that stem cell activity targets neurogenic inflammation, which is a well-documented aspect of migraine pathogenesis. METHODS Adult patients with severe migraine-related disability as measured by the Migraine Disability Assessment (MIDAS) score who failed botulinum toxin injections and at least 3 prophylactic drugs were included in this study. The primary outcome measure was the change in MIDAS score 3 months after treatment. Standard liposuction was performed to obtain adipose tissue, from which SVF was isolated by centrifugation. A sample of each patient's SVF was tested for the number of nucleated cells and their viability. Between 8 and 10 mL of SVF with 2.5-8.6 million viable cells were injected into the pericranial, neck, and trapezius muscles. RESULTS One man and 8 women were enrolled in the study. The mean age was 48 years, the mean duration of headaches was 16 years, the mean number of prophylactic drugs tried was 10, and the mean MIDAS score at baseline was 122. Three months after the procedure the mean MIDAS score was 88. Seven out of 9 patients had a decrease in their MIDAS score, but only 2 had meaningful improvement. CONCLUSION The use of autologous adipose-derived SVF may be effective in the treatment of chronic refractory migraines. It is possible that the use of allogenic stem cells could offer a more practical and more effective approach.