THE PREDICTIVE TEST

Try Before You Commit

Before anything permanent, a small dose of lidocaine tells us whether the pathway behind your migraines will respond. About 3 in 4 patients who reach the test screen positive.

How the Test Works

Lidocaine, delivered to the source

Before any permanent decision, we deliver a small amount of lidocaine to the middle meningeal artery (MMA) — the vessel that supplies the dura, the pain-sensitive lining of the brain. We then monitor your migraine pain over the next 90 minutes.

If your headache responds during that window, we know this pathway drives your migraines. If it doesn't, we stop — the catheter comes out and you go home the same day.

Two ways to test positive
Acute responder
Significant pain relief shortly after lidocaine delivery. You'll know before you leave the procedure room whether this pathway is driving your migraines.
Delayed responder
Progressive improvement over the following weeks. Some pathways calm gradually — you may still qualify even without instant relief in the chair.
A physician talking with a patient in the angiography suite

Every part of this process is designed so that nothing permanent happens until the test says so. The result means one of two things:

✓
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 test positive.
What the result means
We measure your pain over the 90-minute monitoring window. A positive test means your pain dropped by at least 50%. A stronger response — a drop of around 80% or more — is a highly positive result, and the strongest predictor of long-term success. Relief from the test itself is temporary: it typically lasts 4 to 24 hours, though it can last longer. And some patients respond over days instead of minutes — which is why the headache diary you keep after the test matters.
And if it's negative?
A negative test is not bad news — it's valuable information. No embolization is performed. No coils placed, no arteries altered. The lidocaine wears off within hours. You go home knowing this treatment isn't right for you — before spending more time, money, and hope on something that wouldn't have helped.
Before Your Test

How to prepare for your test day

Nothing to eat for 8 hours before
No solid food in the 8 hours before your test. Clear fluids are OK.
Arrange a ride home
You cannot drive after sedation, so plan for someone to drive you home the same day.
Take your usual medications
Keep taking your migraine medications unless we tell you otherwise. Tell us about blood thinners — we may ask you to pause them before the test.
Keep a simple headache diary
In the month before the test, note your headache days, pain levels, and what you take. This helps us interpret your results.
Keep the diary going after the test, too
Track your headaches for 2 weeks after the test. If your headache frequency drops by 50% or more over those 2 weeks compared with your baseline month, that also counts as a positive result — some pathways calm over days instead of minutes.
On Test Day

What to expect on test day

The test follows the same steps as a standard diagnostic angiogram. Here's how the day goes:

1
Consultation
Review your migraine history and imaging with a neurointerventional surgeon. We confirm you may benefit from testing.
2
Catheter access
A small catheter is threaded through the wrist or groin — similar to a standard cardiac catheterization. This is done under mild sedation; you remain comfortable throughout.
3
Lidocaine delivery
The catheter is guided to the middle meningeal artery (MMA) and a small dose of lidocaine is delivered.
4
Response assessment
We assess your response throughout the procedure and afterwards while you relax in our recovery area. A meaningful reduction in pain over the 90-minute monitoring window qualifies as a positive test.
5
Same-day discharge
Regardless of outcome, you go home the same day. No overnight stay. If the test is negative, no permanent procedure is performed — zero risk taken.
The diagnostic angiogram and lidocaine test are typically covered by insurance.
Why We Test First

No other migraine procedure offers this

With Botox® — 31 injections every 12 weeks, indefinitely — and CGRP inhibitors — ongoing monthly injections or daily pills — you commit to ongoing treatment and hope it works. Neither offers any way to predict whether it will help you.

This is different. The lidocaine test gives you a definitive answer before any permanent decision is made. You know whether the pathway driving your migraines responds — before you commit to anything.

3 out of 4
patients test positive on the lidocaine screen
~90%
of test-positive patients respond after embolization
0
serious complications across published studies
Test positive? Here's what happens next.
The TEMMA® Procedure
Common Questions

Questions about the lidocaine test

Test first. Then treat.

Schedule a consultation. If the lidocaine test is right for you, we'll schedule it — nothing permanent happens until the test says so.

Request a ConsultationCall (833) 4-CORTEX