Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited small vessel disease characterised by recurrent ischemic stroke, cognitive decline progressing to dementia, psychiatric disturbances and apathy. More than half of mutation carriers suffer from migraine, most often migraine with aura. Recently, a CADASIL patient was treated with a monoclonal antibody targeting the calcitonin gene-related peptide (CGRP) receptor. Monoclonal antibodies targeting the CGRP system have been demonstrated to be safe, well tolerated, and effective in reducing migraine attacks. There is, however, abundant evidence that CGRP is important in maintaining cardiovascular homeostasis under (patho)physiological conditions. CGRP may act as a vasodilatory safeguard during cerebral and cardiac ischemia and blockage of the system could, therefore, potentially worsen ischemic events. Therefore, we caution against treating patients with small vessel diseases, such as the monogenic disorder CADASIL, with these drugs until relevant safety data and long term follow up results are available. Alternative preventive migraine treatments in CADASIL may be acetazolamide, sodium valproate, lamotrigine, topiramate, verapamil, or flunarizine.

伴有皮质下梗死和白质脑病的常染色体显性遗传性脑动脉病 (CADASIL) 是一种遗传性小血管疾病，其特征是复发性缺血性中风、认知能力下降发展为痴呆、精神障碍和冷漠。超过一半的突变携带者患有偏头痛，最常见的是先兆偏头痛。最近，一名 CADASIL 患者接受了一种针对降钙素基因相关肽 (CGRP) 受体的单克隆抗体治疗。针对 CGRP 系统的单克隆抗体已被证明是安全的、耐受性良好且可有效减少偏头痛发作。然而，有大量证据表明 CGRP 在（病理）生理条件下对维持心血管稳态很重要。CGRP 可能在脑和心脏缺血期间充当血管舒张保护剂，因此，系统的阻塞可能会加重缺血事件。因此，在获得相关安全性数据和长期随访结果之前，我们警告不要使用这些药物治疗患有小血管疾病（例如单基因疾病 CADASIL）的患者。CADASIL 中的替代预防性偏头痛治疗可能是乙酰唑胺、丙戊酸钠、拉莫三嗪、托吡酯、维拉帕米或氟桂利嗪。