Middle meningeal artery lidocaine infusion for refractory headache

Refractory headache is a common and frequently disabling disorder, affecting 2-12 million patients each year in the US alone. This case series provides initial insight into the safety and effectiveness of lidocaine infusions into the middle meningeal artery (MMAL) for the treatment of refractory headache.

A retrospective review of a prospectively maintained database was conducted to identify patients undergoing MMAL at two institutions. Baseline demographics, procedural metrics, and headache measures were tracked over a 3 month period. Headache severity was assessed immediately after the procedure, and at 1, 2, and 3 months. A responder was defined as a patient who had a >50% reduction in headache days per month.

45 patients (38 women, average age 49.8 years) underwent treatment at two institutions over 19 months. The patients reported an average of 27.5 headache days per month despite medical therapy during the month before treatment. All infusions were performed under conscious sedation and most (40, 88.9%) were performed via radial access. No neurological complications were observed. The most common adverse event (4 of 45 patients) was discomfort at the radial access site. 29 of 45 (64.4%) patients reported headache relief immediately (0-24 hours) after the infusion. At 1, 2, and 3 months, 57% (24 of 42), 34% (13 of 38), and 20.6% (7 of 34) of patients were responders. All but one (23 of 24) of the patients who were responders at 1 month had experienced acute headache relief during (or immediately after) the lidocaine infusion procedure. 23 of 27 (85.1%) patients who had relief during the procedure were responders at 1 month. Headache Impact Test-6 (HIT-6) scores were 69.4 before treatment (41 patients), 55.5 (34) at 1 month, 64.5 (31) at 2 months, and 66.0 (31) at 3 months.

The study found that MMAL can elicit relief in patients with refractory headache, which may last as long as 3 months. Most patients who had acute relief during the procedure were responders at 1 month.