Abstract Body: Introduction: Migraines are a leading cause of long-term disability. A vascular cause of migraines was the basis of early pharmacological treatments that attempted to constrict the meningeal artery as it was seen be a source for these headaches. The middle meningeal artery (MMA) is known to be a significant driver in subdural headaches resulting from subdural bleeds and its embolization is widely accepted as a treatment approach in these cases. Our study aimed to evaluate the safety and efficacy of MMA embolization (MMAE) for refractory migraines.

Hypothesis: MMAE will significantly decrease the quantity and severity of migraine headaches post-embolization.

Methodology: Our study was conducted by a self-control pilot study on 10 participants that were refractory to conventional pharmaceutical treatments. Embolization side was chosen based on side of symptom predominance. The common parameters describing the severity, frequency and associated subjective complaints of migraine commonly used and reported in the literature were selected for evaluating the outcome of the MMA embolization. These include: (1) pain measurement by Visual Analogue Scale (VAS), Verbal Rating Scale (VRS) and Numerical Rating Scale (NRS); (2) Migraine Disability Assessment (MIDAS) including days of headache and disability within 3 months; (3) Migraine-Specific Questionnaire (MSQ) (4) The Headache Impact Test-6 (HIT-6); (5) Hospital Anxiety and Depression Scale (HADS); (6) Clinical Global Impressions Scale (CGI). Safety outcome parameters included procedure-related complication, other adverse events and worsening of the headache. Severity illness(SI), Global improvement (GI), and Efficacy index(EI) were also recorded.

Results: There were significant decreases in VAS score, NRS score, Days of HA/Month, Days of HA/3 Month, Days of HA Drugs Month, Days of disability, HIT6, MSQ, Total score, RR, RP, Depression score, Anxiety score, SI, GI, and EI before and after embolization (P<0.05[MM1] . No peri-procedural complications occurred during the study.

Conclusions: Our pilot study demonstrated a safe and effective treatment profile of MMAE for the treatment of chronic headaches. Future randomized control studies are needed to provide a definitive clinical value on the safety, efficacy and cost-effectiveness of this treatment strategy.