Headache resolution following middle meningeal artery embolization in chronic subdural hematoma patients

Headache is a common but underrecognized symptom in patients with chronic subdural hematoma (cSDH). Middle meningeal artery embolization (MMAe) has emerged as a minimally invasive treatment for cSDH, but its impact on headache remains unclear. We conducted a retrospective cohort study of cSDH patients presenting with headache who underwent MMAe between July 2019 and June 2025, excluding those with prior surgical intervention, ventricular shunts, or Glasgow Coma Scale < 14. Clinical, imaging, and procedural data were collected, including headache status 2-6 weeks post-procedure. Of 135 patients who underwent MMAe, 78 (58%) presented with headaches, and 30 met inclusion criteria. Twenty-one (70%) reported complete headache resolution, and 6 of 9 remaining patients (67%) reported improvement, resulting in a combined resolution or improvement rate of 90% (77-99%, p < 0.001). No procedural complications occurred. Headache outcomes were not significantly associated with baseline demographics, clinical variables, or follow-up hematoma characteristics, including resolution (p = 0.999), thickness (p = 0.758), or midline shift (p = 0.318). These findings indicate that MMAe is associated with significant short-term headache improvement in cSDH patients, independent of hematoma size or mass effect. This supports further investigation into MMAe's potential role in managing both secondary headaches from cSDH and primary headache syndromes.