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Introduction Refractory chronic migraine (RCM) is defined as experiencing 15 headache days per month despite standard treatment. RCM affects approximately 5% of migraine patients. Preliminary studies have demonstrated improvement in CM among patients who underwent middle meningeal artery (MMA) procedures, including bilateral lidocaine infusions or permanent MMA embolization.Aim of Study MIGRAINE ( NCT06735833, Johnson&Johnson) is a prospective, single-arm, early feasibility study designed to assess the safety and effectiveness of MMA embolization with TRUFILL® n-Butyl Cyanoacrylate (n-BCA, Johnson&Johnson) in patients with RCM.Method MIGRAINE will enroll 30 subjects across up to 5 US centers beginning Q2–2025. Participants will undergo screening/baseline assessment by completing a daily headache diary for 28 days, followed by bilateral MMA embolization using TRUFILL n-BCA, and will continue the daily headache diary over 6 months. An independent Data Monitoring Committee will assess and monitor all adverse events (AEs) and interim data.Results The primary effectiveness endpoint will be the change from baseline in the number of migraine days over 28 days post-intervention. Other endpoints will include new disabling stroke or death from any neurological cause over 4 weeks. Serious AEs through 1 year, and additional endpoints assessing change in frequency and/or severity of CM symptoms and medication use at 1, 3, 6, and 12 months with a total follow-up period of 3 years.Conclusion The MIGRAINE study will provide initial data on the safety and effectiveness of TRUFILL n-BCA for MMA embolization in patients with RCM. The results may be used to inform future MMA embolization migraine studies.Conflict of Interest Yes David Fiorella-- Consultant: Arsenal Medical, Medtronic, Cerenovus, MicroVention, Penumbra, Stryker, Balt USA, MENTICE Vascular Simulations, Neurogami, NVMed, Q’apel Medical, RAPID. AI, RAPID Medical, Phenox Medical, Scientia Medical, Perfuze, Seimens, Vesalio; Proctor: Medtronic, MicroVention; Research support: MicroVention, Penumbra, Stryker, Balt USA, Siemens; Advisory board: Arsenal Medical, NVMed, Perfuze, Scientia Medical; Stockholder: Neurogami, Arsenal Medical, Scientia Medical, MENTICE Vascular Simulations, NVMed, and Perfuze; Speaker honoraria: Medtronic, Cerenovous, Microvention, Penumbra, Stryker, Balt USA, Q’apel Medical; Travel expenses: Medtronic, Cerenovous, Microvention, Penumbra, Stryker, Balt USA, Seimens, Mentice, Neurogami, Rapid.AI, Rapid Medical, Q’apel Medical, Arsenal Medical, Phenox, Scientia, NVMed, Perfuze, Vesalio; Leadership role: Scientia, MENTICE, Neurogami, NVMed, Perfuze. Stephen D Silberstein-- Consultant and/or advisory panel member for and has received honoraria from: Alder Biopharmaceuticals, AbbVie, Amgen, Avanir, Curelator Inc., eNeura, electroCore Medical, GlaxoSmithKline Consumer Health Holdings, Impel NeuroPharma, Eli Lilly and Company, Labrys Biologics, Lundbeck, Medscape, Medtronic, Neuralieve, NINDS, Pfizer, Salvia BioElectronics, Satsuma Pharmaceuticals, Teva Pharmaceuticals, Theranica, Thermaquil, and Trillen Medical; Employer receives research support from: AbbVie, Amgen, Cumberland Pharmaceuticals, electroCore Medical, Labrys Biologics, Eli Lilly, Mars, and Troy Healthcare; Receives, or has received, honoraria from: AbbVie, Amgen, Aeon BioPharma, Axsome Therapeutics, Curelator, Inc., Epalex, GlaxoSmithKline Consumer Health Holdings, LLC, electroCore Medical, LLC, Impel NeuroPharma, Inc., Lilly USA, LLC, Medscape, LLC, Lundbeck, Nocera, Pulmatrix, Revance, Salvia BioElectronics, Satsuma Pharmaceuticals, Teva Pharmaceuticals, Theranica, Thermaquil, and Trillen Medical Inc. Hsiangkuo Yuan-- Institutional support for serving as an investigator: Teva, Abbvie, and Thermaquil; Consultant fees: Salvia, Abbvie, Pfizer, and Cerenovus; Royalties: Cambridge University Press and MedLink; Funding: NIH (R44NS115460); Personal fees: Abbvie, Pfizer, Salvia, and Cerenovous; Nonfinancial support as a site investigator: Abbive, Ipsen, and Teva. Adam S. Arthur--Consultant services: Arsenal, Balt USA, LLC, Johnson and Johnson International, Medtronic USA Inc, Microvention Inc, Penumbra Inc, Perfuze, Scientia, Siemens Medical Solutions USA Inc, and Stryker Corporation; Personal fees: Balt, Cerenovus, Medtronic, Microvention, Penumbra, Scientia, and Stryker; Shareholder: Azimuth, Bendit, Cerebrotech, Endostream, Magneto, Mentice, Neurogami, Neuros, Perfuze, Revbio, Scientia, Serenity, Synchron, Tulavi, Vastrax, VizAI; Research support: Balt, Medtronic, Microvention, Penumbra, and Siemens.