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The middle meningeal artery (MMA) has emerged as a potential therapeutic target for severe, treatment-resistant headache syndromes. Growing evidence suggests that the MMA and its dural branches are active participants in nociceptive signaling within the trigeminovascular system. 1 2 This pathway, implicated in migraine and other cranial nerve V-driven headache disorders, involves activation of perivascular nociceptors, release of pro-inflammatory mediators, and secondary vascular changes.3 Recent reports have demonstrated that intra-arterial lidocaine infusion into the MMA or MMA embolization can provide rapid and sometimes sustained relief in patients with chronic refractory headache, with minimal procedural risk.4–6