1 Clinical Correspondence Embolization of Middle Meningeal Artery for the Treatment of Headaches Induced by Chronic Subdural Hematoma: A Case Report Pouya Entezami, MD; Emad Nourollahzadeh, MD; John Dalfino, MD Key words: subdural hematoma, endovascular, embolization, middle meningeal artery (Headache 2019;0:1-4) Headaches caused by chronic subdural hema- tomas (CSDHs) in patients who are otherwise neu- rologically intact are difficult to manage. It is often challenging to commit mildly symptomatic patients to craniotomy – the gold standard in management. We report the case of a patient with small CSDH managed by embolization of the middle meningeal artery (MMA), resulting in immediate symptom- atic improvement and resolution of the hematoma over time. Arterial embolization is a relatively quick and safe procedure that may allow for a minimally invasive treatment option in patients who may not be great candidates for open cranial surgery. The management of CSDH can be challeng- ing, especially in patients who are asymptomatic or with mild complaints. Headache is often an associ- ated symptom of these injuries. 1 Trephination is the first recorded treatment for headaches, performed in order to free evil spirits from a patient’s head. 2 While burr-hole irrigation or craniotomy for hematoma evacuation remains the primary treatment option for CSDH, recurrence rates remain high. 3,4 The morbid- ity and risks associated with surgery often make this a poor option for those with benign symptoms such as mild headaches. Endovascular management of CSDH via embolization of the MMA has yielded promising results. 3 However, most reports in the current litera- ture discuss patients who underwent MMA emboli- zation in combination with surgical evacuation, often after recurrence of the hematoma after initial surgical evacuation. We present a patient with persistent head- aches secondary to CSDH managed by MMA embo- lization alone. An 84-year-old male presented several days after a fall from standing with progressively worsen- ing headaches over the course of 1 week. Computed tomography (CT) imaging revealed a 9-mm right fron- tal CSDH, with 4 mm of midline shift (Fig. 1). While his neurological examination remained intact, he had become progressively more reliant on narcotic ther- apy for headache control during his hospitalization. Headache doi: 10.1111/head.13519 © 2019 American Headache Society Published by Wiley Periodicals, Inc. ISSN 0017-8748 Conflict of interest: The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. Financial support: None. From the Department of Neurosurgery, Albany Medical College, Albany, NY, USA (P. Entezami, E. Nourollahzadeh, and J. Dalfino). Address all correspondence to P. Entezami, Department of Neurosurgery, Albany Medical College, 47 New Scotland Ave, MC-10, Albany, NY 12208-3479 USA, email: entezap@amc.edu Accepted for publication February 8, 2019.