Question 1

What is TEMMA®?

Accepted Answer

TEMMA® stands for Targeted Embolization for Migraine Management. It is a minimally invasive procedure that blocks specific arteries that supply the dura — the pain-sensitive lining of the brain. A catheter is threaded from the groin or wrist to these vessels, and a tiny platinum coil is placed to reduce their blood flow — which reduces migraine frequency and severity in appropriately selected patients.

Question 2

Who is a candidate for TEMMA®?

Accepted Answer

TEMMA® is designed for patients with severe migraine (8+ headache days per month) who have not found adequate relief from standard treatments. A consultation and imaging review will determine candidacy. Not everyone qualifies — careful patient selection is central to our approach. We review your MRI/MRA to confirm anatomy and rule out other causes before proceeding.

Question 3

What is the lidocaine test?

Accepted Answer

Before any permanent decision, we deliver a small amount of lidocaine to the target pathway and monitor your migraine pain over the next 90 minutes. If your headache responds, we know this pathway drives your migraines and can proceed with confidence. If it doesn't help, we stop — no permanent changes, no risk taken. About 3 in 4 patients who reach the test screen positive.

Question 4

What if the lidocaine test is negative?

Accepted Answer

You go home. No embolization is performed. No harm done. The catheter is simply removed and you recover quickly. The test is a safety net — you never commit to a procedure without strong evidence it will work for you.

Question 5

Is TEMMA® covered by insurance?

Accepted Answer

The diagnostic angiogram and lidocaine test are typically covered by insurance. The embolization procedure for migraine is not yet universally covered — though coverage is expanding as evidence grows. We help you understand costs and navigate coverage options before any procedure. Our team works with you on prior authorization and can provide the clinical documentation your insurer needs.

Question 6

What results can I expect?

Accepted Answer

In the published studies, most treated patients improve — roughly 9 in 10 across the reported series. In a 10-patient test-first series, migraine-impact scores (HIT-6) improved by 30.5 points on average — from "severe" toward "little or no impact" — with relief sustained at 6 months. In US hospital series, 8 of 9 patients with severe chronic headaches improved after embolization, 7 with complete resolution. Individual results vary, and we track your progress over the next 12 months.

Question 7

How long does the procedure take?

Accepted Answer

The embolization itself takes 40 minutes. Plan for about 4 hours total on procedure day, including preparation, the procedure, and recovery. The embolization is scheduled as a separate visit after a positive lidocaine test.

Question 8

Is it painful?

Accepted Answer

The procedure is performed under mild sedation. You remain conscious and comfortable. The catheter access site receives local anesthesia, so you feel numbness and pressure but not sharp pain. Most patients describe it as less uncomfortable than a typical dental visit.

Question 9

What does recovery look like?

Accepted Answer

Most patients go home the same day, typically 2–3 hours after the procedure. You'll have a small bandage at the catheter access site. For the first 48 hours: no driving and no strenuous activity. Most patients return to normal daily activities the next day. Mild discomfort at the access site is normal for 1–2 days. We follow up with you over the next 12 months to track your progress.

Question 10

What are the risks?

Accepted Answer

Common: mild bruising and soreness at the catheter access site (wrist or groin), which resolves in a few days. Some patients experience a mild headache for 1–2 days post-procedure. Rare: allergic reaction to contrast dye, vessel injury during catheterization, or infection at the access site. Across published studies to date, zero serious complications have been reported for this indication. The technique has been used safely in neurointerventional surgery for decades.

Question 11

Will the treated artery grow back?

Accepted Answer

No. The platinum coil causes permanent occlusion of the middle meningeal artery — it will not recanalize. In some cases, small collateral vessels may form over time as the body naturally adapts, but these rarely affect your outcome. Published follow-up data shows sustained relief at 6–12 months and beyond.

Question 12

What if I need an MRI later?

Accepted Answer

The platinum coil is MRI-safe. You can have MRI scans after the procedure without any concerns. The coil may produce a small artifact on imaging near the embolization site, which is completely normal and expected — radiologists are familiar with this. It will not interfere with reading your scan or diagnosing other conditions.

Question 13

Does closing this artery cause problems?

Accepted Answer

The middle meningeal artery does not supply the brain itself. It supplies the dura — a pain-sensitive membrane. Closing it has been done safely in neurosurgical procedures for decades without affecting brain function. The key structures of the brain, including all major cerebral arteries, are completely unaffected. The body compensates through other vessels that continue to supply the dura.

Question 14

How is TEMMA® different from Botox® or CGRP inhibitors?

Accepted Answer

Botox® requires 31 injections every 12 weeks indefinitely, and there is no way to predict if it will work. CGRP inhibitors are ongoing monthly injections or daily pills, also with no predictive test — you try them and hope. TEMMA® is a single procedure with a predictive lidocaine test. You know before you commit whether it will work for you, and if it does, there are no ongoing treatments required.

Question 15

How was this discovered?

Accepted Answer

MMA embolization has been used for decades to treat chronic subdural hematoma — a condition where blood collects between the brain and its protective membrane. Clinicians noticed that patients who also had migraines saw their headaches disappear after the procedure. That observation — migraine relief as a side effect of a neurosurgical treatment — is how this new indication was discovered. TEMMA® applies a proven, safe technique to a new purpose.

Question 16

Why hasn't my neurologist told me about this?

Accepted Answer

MMA embolization for migraine is emerging and not yet widely known among headache specialists. Most neurologists don't yet refer for it — the first case series was published in 2021, and the field is still early. That doesn't mean it doesn't work — it means the word is still spreading. We're happy to coordinate with your current care team and share the published evidence.

Question 17

Can I stop my current migraine medications?

Accepted Answer

That depends on your individual situation and should be discussed with your treating physician. Many patients do reduce their medication use after TEMMA® — some significantly. But TEMMA® is not a guarantee you can discontinue all other treatments. Some patients continue their current treatments at lower doses; others find they no longer need them. We work with your existing care team to manage any medication changes safely.

Question 18

How do I get started?

Accepted Answer

Call us at (833) 4-CORTEX or request a consultation online. We'll review your migraine history, discuss whether TEMMA® is appropriate, and schedule the lidocaine test if you're a candidate. We can also coordinate with your current neurologist or headache specialist — most patients keep seeing them for day-to-day medication management while we handle the interventional side.

Question 19

Will Cortex Migraine replace my current doctor?

Accepted Answer

No. We are an interventional practice — the lidocaine test and the TEMMA® procedure. Day-to-day migraine medication management stays with your neurologist or primary care provider, and we keep them in the loop: with your permission, we send our consultation notes, test results, and procedure report to their office. Most patients continue seeing their regular doctor, with our findings added to the picture.

Question 20

How soon will I notice improvement?

Accepted Answer

Some patients notice improvement within days of the procedure; most improve over the following weeks. The full benefit may take up to 3 months.

Question 21

How long does the benefit last?

Accepted Answer

The treated artery stays sealed, and patients in published studies have kept their relief through follow-up. Research on long-term durability is ongoing — we check your progress over the next 12 months.

Question 22

Can the coil move or come out?

Accepted Answer

No. The coil is deployed and stays in place within the artery — it is designed for permanent placement. It does not interfere with future MRI scans or other migraine treatments.

Question 23

Is TEMMA® brain surgery?

Accepted Answer

No. There are no incisions in the head or skull. Everything is done through a small puncture in the wrist or groin, with a thin catheter threaded through the blood vessels to the target artery.

Question 24

What happens at a first consultation?

Accepted Answer

We review your migraine history in detail — frequency, severity, what you've tried, and what imaging exists. If you may be a candidate for the interventional pathway, we discuss the lidocaine test and answer every question before anything is scheduled. Plan on about an hour.

Question 25

Do I need a referral?

Accepted Answer

No referral is required to schedule a consultation. Many patients are referred by their neurologist or primary care provider, and we coordinate with your existing care team throughout.

Question 26

Which locations offer which treatments?

Accepted Answer

Consultations are available at our open Cortex Migraine locations — Tacoma, Olympia, and Los Angeles — with more locations coming soon in the Bay Area, Las Vegas, Phoenix, and Denver. Botox® is offered at selected locations, and TEMMA® procedures are performed at our dedicated procedure locations — all coordinated at your consultation.

Question 27

Do you see patients from out of town?

Accepted Answer

Yes. We regularly work with patients traveling for evaluation and treatment, and we coordinate scheduling so the lidocaine test and any follow-up fit into efficient trips. Contact us and we'll help you plan it.

Frequently Asked Questions

About TEMMA®

Botox® for Chronic Migraine

Visiting Cortex Migraine

Still have questions?