Middle meningeal artery lidocaine infusion reduces headache after venous sinus stenting for idiopathic intracranial hypertension.

BACKGROUND: Headaches after venous sinus stenting (VSS) for idiopathic intracranial hypertension (IIH) are very common and challenging to manage. We evaluated the safety and efficacy of middle meningeal artery (MMA) lidocaine infusion to mitigate post-VSS cephalalgia. METHODS: We retrospectively reviewed 50 consecutive patients with medically refractory IIH who underwent VSS at a single institution (February 2024-January 2026). Seven patients received bilateral MMA infusion of 50 mg of 1% lidocaine immediately following stent deployment; 43 patients served as controls. The primary outcome was first-day headache burden (normalized sum of VAS scores). Secondary outcomes included total in-hospital opioid consumption (oral morphine equivalents, OME) and procedural complications. RESULTS: Baseline characteristics and procedural metrics were comparable between groups. The MMA lidocaine infusion group demonstrated a 52% reduction in median first-day headache burden compared to controls (15.1 vs. 31.0; P = 0.012). Opioid consumption was reduced by 83.2% in the treatment arm (median 2.8 mg vs. 16.7 mg; P = 0.008). No complications related to MMA infusion occurred, and all infused MMAs remained patent. No seizures or other neurological or cardiovascular complications were observed. CONCLUSION: MMA lidocaine infusion may significantly reduce acute pain burden and opioid requirements following VSS in IIH patients. Prospective trials are warranted to confirm the safety and efficacy of this intervention.