In a prospective, self-controlled trial published in 2026, 15 patients who had failed multiple medical therapies underwent embolization of the middle meningeal artery on the side of their predominant symptoms. Headache days per month, pain scores on every scale measured, medication use, quality of life, and disability all improved significantly at 3-month follow-up — with no major neurologic complications.
Source: Xu et al., Int J Surg 2026 — FAST-EM trial, China (n=15)
In a 2025 series of 10 patients with chronic and refractory migraine — all of whom had first confirmed positive on a lidocaine suppression test — bilateral occlusion of the middle meningeal artery improved HIT-6 scores by 30.5 points on average, sustained through 6-month follow-up, with no neurological or technical complications observed.
Source: Vanzin & Manzato, Interv Neuroradiol 2025 (n=10)
At Barrow Neurological Institute, 8 of 9 patients who underwent middle meningeal artery embolization (to treat chronic subdural hematoma) and also had chronic headaches improved meaningfully — and 7 of those 8 achieved complete resolution. Mean HIT-6 fell from 64 to 40. These patients were not treated for migraine; the relief was an unanticipated benefit, and the observation that helped launch this new indication. It was the first case series from a major US academic center to report headache outcomes after MMA embolization.
Source: Catapano et al., J Neurointerv Surg 2022 (n=9)
A 2026 series from Johns Hopkins University — the largest US report of headache outcomes after MMA embolization — followed 30 patients who had chronic headaches before undergoing the procedure for chronic subdural hematoma. Seventy percent reported complete headache resolution at follow-up, and 90% reported resolution or improvement. As at Barrow, these patients were treated for another condition — the headache relief was an unanticipated benefit that reinforces the generalizability of the pathway.
Source: Feghali et al., J Clin Neurosci 2026 (n=30)
In the first published case series for this indication (2021), VAS pain scores dropped from 8–10 out of 10 to 0 immediately after the procedure. In patients with status migrainosus — an attack lasting more than 72 hours that does not respond to medication — lidocaine delivered directly into the MMA produced an immediate drop in headache intensity, and MIDAS disability scores fell from 30 to 3 and from 90 to 55 at three months: a shift from “severe disability” to “little or no disability.”
Source: Qureshi et al., J Neuroimaging 2021 (n=4)
In a prospective study of 8 patients, lidocaine delivered directly into the MMA — with no embolization — still produced improvement at 3 months: average MIDAS disability scores fell from 86 to 24 (every patient started in the severe disability range), 62.5% of patients improved by at least half, and half reached MIDAS Grade 1 ("no disability"). Three of the four opioid users stopped opioids during follow-up, and there were zero adverse events. This was the first study to quantify the dose response of lidocaine in the artery on angiography.
Source: Fakih et al., J Neuroimaging 2025 (n=8)
In a prospective series of 7 patients with severe headache after a brain bleed (subarachnoid hemorrhage), lidocaine delivered into the MMA improved headaches in all 7 — with immediate, complete resolution in 4. Angiography showed the middle meningeal artery measurably narrowing after lidocaine: the first study to demonstrate that lidocaine reverses the artery dilation linked to headache pain — the mechanism behind the lidocaine test.
Source: Qureshi et al., Interv Neuroradiol 2025 (n=7)
In a series of 10 patients with severe migraine who underwent surgical ligation of the middle meningeal artery (along with the adjacent superficial temporal artery and greater superficial petrosal nerve), none had recurrence of their migraines at follow-up ranging from 2 to 18 years — early evidence that physically eliminating the artery’s contribution to the headache circuit can produce very durable relief.
Source: Zhaomin et al., 2006 (reviewed in Boyett et al., Surg Neurol Int 2025)
Magnetic resonance angiography studies show that the middle meningeal artery dilates on the pain side as a migraine-like attack begins, and remains dilated into the late phase of the attack. Sumatriptan — the most established migraine abortive drug — constricts the MMA and the other external vessels while the deeper brain arteries show no comparable constriction: direct evidence that this single artery is uniquely involved in migraine pain.
Source: Khan et al., Brain 2019;142:93–102
Triptans, DHE, CGRP inhibitors, and NSAIDs all reduce signaling in the dural vessels. TEMMA® provides a longer-lasting version of this same effect — as a one-time procedure rather than ongoing medication.
Source: Multiple pharmacology reviews