Background Several studies have demonstrated the amelioration of refractory migraines with middle meningeal artery (MMA) lidocaine infusion but the durability beyond 1 month is not well studied. The angiographic dose response of lidocaine infusion was not previously evaluated. Methods We quantified the response to intra‐arterial lidocaine infusion (maximum dose of 150mg) in patients with refractory migraine using the Migraine Disability Assessment (MIDAS) evaluated pre‐ and post‐treatment. We determined the MIDAS score changes, the proportion of responders (≥50% MIDAS reduction), the proportion of patients with “no disability” (MIDAS Grade 1) at 3 months, and the cessation of opioid medication for headache management measured at the last known follow‐up. An angiographic dose response was quantified. Results Eight patients were included in our analysis (mean age±SD was 49.1±13.2 years; 87.5% were women). The cohort comprised equal numbers of unilateral and bilateral MMA lidocaine infusions (4 each), with doses titrated from 50‐150 mg per procedure. At 3 months post treatment, the mean MIDAS score improved from 86.3 ± 40.1 to 23.5 ± 26.8 (p=0.001, paired t‐test) and 62.5% of the patients showed 50% MIDAS score reduction. The disability pre‐treatment was classified as “severe disability” in all patients, and 50% achieved “no disability" (MIDAS Grade 1) at 3 months post treatment. No adverse events were reported in any of the procedures. At last known follow up of a median period of 9.8 months range 4 ‐ 21 months, three out of the four patients who were on opioid medication pre‐treatment, discontinued their opioid medications following MMA lidocaine infusion. Conclusion MMA lidocaine infusion provided sustained improvement at 3 months post treatment in patients with refractory migraines.
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