MMA Infusion of Lidocaine for Treatment of Headache in Patients With Aneurysmal SAH

The purpose of the MIL-SAH trial is to evaluate the efficacy and safety of middle meningeal artery (MMA) lidocaine infusion for the treatment of headache in patients with aneurysmal subarachnoid hemorrhage (SAH). The trial aims to determine whether MMA lidocaine infusion reduces headache severity during the first 72 hours following endovascular aneurysm treatment compared with placebo.

Inclusion criteria 1. Age ≥ 18 years 2. Imaging showing a SAH and intracranial aneurysm 3. Undergo endovascular therapy within 72 hours\* 4. Glasgow coma scale (GCS) score of 14-15 5. Maximum headache severity of NRS score ≥ 4 at a time \> 1 hour after ictus or the ad-ministration of opioids due to headache Exclusion criteria 6. The patient is unable to understand information provided in the national language or English 7. Known allergies to amide-type local anesthetics or iodinated contrast media 8. Pregnancy or lactation 9. Severe hepatic impairment 10. History of epilepsy 11. History of chronic opioid use 12. Renal impairment with eGFR \< 30 mL/min/1.73m2 13. Current treatment with class III antiarrhythmics (e.g. amiodarone) 14. Atrioventricular block of II and III degree 15. Unsuccessful endovascular aneurysm securement or procedural complications