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Published on: February 22, 2013
Chronic headaches and middle meningeal artery embolization
Joshua S Catapano1, Katherine Karahalios1, Visish M Srinivasan1
1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Insights
Middle meningeal artery embolization improved chronic headaches in most patients with chronic subdural hematoma. This minimally invasive procedure offers a potential new treatment for persistent headaches.
Area of Science:
- Neurology
- Interventional Radiology
- Neurosurgery
Background:
- The middle meningeal artery (MMA) is linked to chronic headaches.
- No prior studies have investigated MMA embolization for headache treatment.
Purpose of the Study:
- To evaluate the effectiveness of MMA embolization in resolving or improving chronic headaches in patients with chronic subdural hematoma (cSDH).
Main Methods:
- Retrospective analysis of patients treated for cSDH with MMA embolization (2018-2020).
- Follow-up calls assessed chronic headache history (≥2 years) and symptoms (≥2 days/month).
- Headache Impact Test-6 (HIT-6) scores were recorded before and after embolization.
Main Results:
- Of 46 analyzed patients, 9 (20%) had pre-existing chronic headaches.
- Eight of nine patients reported headache improvement, with seven experiencing complete resolution post-embolization.
- Mean HIT-6 scores significantly decreased from 64.0 to 40.0 (p<0.001) after MMA embolization.
Conclusions:
- MMA embolization appears effective in improving chronic headaches in patients with cSDH.
- Further prospective research is recommended to confirm MMA embolization's utility for treating chronic headaches.
Background:
The middle meningeal artery (MMA) has been implicated in chronic headaches, but no studies have examined the relationship between MMA embolization and headaches.
Methods:
Patients treated with MMA embolization for a chronic subdural hematoma (cSDH) between January 1, 2018, and December 31, 2020, were retrospectively assessed. Patients with a Glasgow Coma Scale (GCS) score of 15 at discharge received a follow-up telephone call to assess their history of chronic headache, defined as a headache ≥2 years before the cSDH and symptoms ≥2 days/month. A Headache Impact Test (HIT-6) was performed during the follow-up telephone call. The primary outcome was resolution or improvement of headaches after embolization.
Results:
Of 76 patients undergoing MMA embolization for a cSDH during the study period, 56 (74%) had a discharge GCS score of 15. Of these 56 patients, 46 (82%) responded to a follow-up telephone call and were analyzed (mean [SD] age 68 [11] years; 36 [78%] men and 10 [22%] women). Nine (20%) reported chronic headaches before embolization. With a mean (SD) follow-up of 489 (173) days, eight of the nine patients reported improvement of chronic headaches, with seven having complete resolution. For these nine patients, the mean (SD) HIT-6 score was significantly higher before embolization than after embolization (64 [7.1] vs 40 [9.1], p<0.001).
Conclusion:
In patients with chronic headaches who underwent MMA embolization for a cSDH, the majority reported improvement of headaches after the procedure. Future prospective studies are warranted to assess the usefulness of MMA embolization to treat chronic headaches.
