Middle meningeal artery embolization for migraine headaches – a prospective self-control cohort trial

BACKGROUND: Migraines are a leading cause of long-term disability. A neurovascular cause of migraines localizing to the middle meningeal artery (MMA), a branch of the external carotid artery, is believed to be a potential underlying mechanism given its anatomical connection to the dura. MATERIALS AND METHODS: We conducted a self-control pilot study of 15 participants with migraine headaches. All patients were recruited in 2024 and were followed for 90 days post-MMA embolization (MMAE). The inclusion criteria used in the study included men and women with age of 18-80 years with migraine with or without aura, intractable migraine with a disease duration of more than 3 months and migraine attacks > 8 times/month in the past 90 days before enrollment: poor response to two or more medications, or intolerable side effects, or the presence of contraindications to medical therapy. MMAE was achieved with coils, and the side of MMAE chosen by the side of symptom predominance. Migraine severity and disability scoring scales were used pre-embolization and three months post-embolization. RESULTS: 329 individuals were screened, and 15 patients were enrolled in the study. There were significant improvements in multiple migraine severity and disability scores, including days of headache a month (Z = - 2.938, P = .003), NRS score (Z = - 3.436, P = 0.001), VAS score (t = 6.085, P<0.001), VRS score (Z = - 4.064, P<0.001), MSQ (t = 4.706, P<0.001), HIT6 (t = 4.730, P<0.001, and MIDAS disability scores (Z = - 3.077, P = 0.002) post-embolization. Medication use decreased significantly (Z = 2.762, P = 0.006). MMAE adverse events included one delayed femoral puncture site hematoma and one post-op transient worsening of chronic back pain. CONCLUSIONS: MMAE for the treatment of refractory migraines appears to be a safe and potentially effective treatment modality. Given the small sample size, no parallel control arm, and unblinded study design with the likelihood of placebo effects, there is limited generalizability of this finding. Future randomized controlled studies are needed to provide a definitive evaluation of the safety, efficacy, and cost-effectiveness of this treatment strategy.