Abstract Details

Title Calcitonin Gene-Related Peptide Inhibitor Use for Migraine Associated with Exacerbation of Raynaud Phenomenon

Topic Headache

Presentation(s) S15 - Headache 2 (2:40 PM-2:48 PM)

Poster/Presentation
Number 005

Background CGRP antagonists have demonstrated tremendous promise in migraine management. These medications can decrease reflex vasodilatory response. This may lead to exacerbation of microvascular disease in susceptible patients, such as in patients with RP.

Objective To investigate microvascular complications of calcitonin gene-related peptide (CGRP) antagonists in patients with underlying primary or secondary Raynaud phenomenon (RP).

Design/Methods

We conducted a retrospective observational study at Mayo Clinic Health System (Arizona, Minnesota, Florida) from May 18, 2018 to September 15, 2020. We reviewed patients with diagnoses of migraine and RP who were prescribed and exposed to CGRP antagonists. We identified patients with microvascular complications following initiation of CGRP antagonist therapy.

Results Of the 169 patients, 9 (5.3%) patients exhibited microvascular complications, ranging from worsening RP to digital gangrene and autonecrosis requiring distal digit amputation. All were female and aged 28 to 56 years. Most patients had chronic migraine (7/9); 4 had migraine with aura (visual) and 5 had migraine without aura. Most (6/9) had previously diagnosed RP, of which 4 were primary and 2 were secondary to scleroderma. The other 3 patients were newly diagnosed with RP following administration of CGRP antagonists. CGRP antagonist agents temporally associated with the microvascular complications included: galcanezumab (in 3 patients), erenumab (in 5 patients), and fremanezumab (in 1 patient).

Conclusions Our results indicate that microvascular complications of CGRP antagonist use in patients with underlying RP are uncommon (5.3%). The incidence of serious adverse events, although rare, warrant caution when considering the use of these agents in patients with RP.

Authors/Disclosures
Ilana Breen (Mayo Clinic) PRESENTER	Ilana Breen has nothing to disclose.
Juliana VanderPluym, MD (Mayo Clinic) PRESENTER	Dr. VanderPluym has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Current Neurology and Neuroscience Reports. The institution of Dr. VanderPluym has received research support from Amgen.
	No disclosure on file
Meera S. Patel, MD (Beaumont Pediatric Neurology)	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file