TEMMA is built on a foundation of neurovascular research that has been accumulating for years. The technique is not new — middle meningeal artery embolization has been used for decades to treat other conditions. What is new is the application of that technique to severe migraine.
Here are the seven most important research findings that together support the use of TEMMA for appropriately selected patients.
Magnetic resonance angiography studies have shown that the middle meningeal artery dilates on the side of the headache at migraine onset, and remains dilated as long as the pain persists. Triptans (the most established migraine abortive drugs) constrict the MMA while leaving other intracranial vessels unchanged — direct evidence that this single artery is uniquely involved in migraine pain.
Source: Khan et al., Brain 2019;142:93–102
Triptans, DHE, CGRP inhibitors, and NSAIDs all reduce signaling in the dural vessels. TEMMA provides a longer-lasting version of this same effect — but as a one-time procedure rather than ongoing medication.
Source: Multiple pharmacology reviews
Among patients who underwent MMA embolization to treat a chronic subdural hematoma (a different condition entirely), 8 of 9 with pre-existing chronic migraine had meaningful headache improvement — and 7 of those 8 had complete resolution. The average Headache Impact Test score fell from 64 to 40. These patients were not treated for migraine; the relief was an unanticipated benefit observed in routine clinical follow-up.
Source: Catapano et al., J Neurointerv Surg 2022;14:301–3
Patients who respond to the diagnostic lidocaine test (Step 2 of the TEMMA process) generally experience the greatest improvement after the full embolization procedure. The lidocaine test is therefore both a diagnostic tool and a predictor of clinical benefit.
Source: Qureshi et al., J Neurointerv Surg 2021 (case series)
A series of 10 patients with severe migraine underwent surgical ligation of the MMA and the adjacent greater superficial petrosal nerve. At follow-up ranging from 2 to 18 years, none of the patients had recurrence of their migraines — early evidence that physically eliminating the artery’s contribution to the headache circuit can produce very durable relief.
Source: Zhaomin et al., 2006 (reviewed in Boyett et al., SNI 2025)
In a series of patients with status migrainosus (a migraine attack lasting more than 72 hours that does not respond to medication), injection of lidocaine directly into the MMA produced an immediate drop in headache intensity, and Migraine Disability Assessment (MIDAS) scores fell from 30 to 3 and from 90 to 55 in the two patients followed at 3 months — a shift from "severe disability" to "little or no disability."
Source: Qureshi et al., 2021 (reviewed in Mancuso-Marcello et al., 2023)