Middle meningeal artery embolization and chronic headache: a mini review

Abstract: Middle meningeal artery (MMA) embolization has emerged as a novel interventional strategy for the management of intractable chronic headache syndromes, particularly in patients with refractory migraine. Despite the number of procedural reports having increased substantially in recent years, there remains no comprehensive review summarizing the mechanistic relationship between MMA embolization and underlying pathophysiology of chronic headaches. This commentary aims to highlight the emerging role of MMA embolization as a potential treatment option for chronic headaches, most notably refractory migraine, and to outline the current evidence as well as future research directions for this evolving therapeutic approach. Conventionally known for its role in treating chronic subdural hematomas (cSDH), MMA embolization has demonstrated efficacy in preventing hematoma recurrence and reducing dural vascularization; its use in this setting has, incidentally, led to a reduction in chronic headache symptoms opening a new frontier to treat those patients burdened with such disabling disease. Additionally, most recent evidence has suggested a far more direct and intentional application of this technique to primary headache disorders, especially chronic migraine, offering a novel approach that targets the dural vasculature as a pain-modulating structure. Although current findings remain preliminary, ongoing randomized trials are expected to better define safety, efficacy and appropriate clinical indications.