Background

Reversible cerebral vasoconstriction syndrome is normally triggered by vasoactive compounds or illicit drugs. A new type of migraine preventive medication blocks calcitonin gene-related peptide utilizing monoclonal antibodies. Calcitonin gene-related peptide is a potent vasodilator for the cerebrovascular system. Could blocking calcitonin gene-related peptide be a trigger for cerebral artery vasospasm in patients susceptible to developing reversible cerebral vasoconstriction syndrome (migraine patients) or in individuals using vasoactive compounds? We present a case of reversible cerebral vasoconstriction syndrome occurring after calcitonin gene-related peptide monoclonal antibody treatment.

Case report

A 43-year -old woman with a history of episodic migraine developed an acute headache with orgasm two days after taking her second injection of erenumab. Ten days after erenumab injection she developed a thunderclap headache while completing a high intensity workout. These new headaches were only left sided. Computed tomography angiography demonstrated mild to moderate areas of narrowing involving the left middle and anterior cerebral arteries, concerning for reversible cerebral vasoconstriction syndrome. She denied exposure to any known reversible cerebral vasoconstriction syndrome precipitant medication or illicit drugs. She did endorse recent exposure to high altitude prior to erenumab therapy. She was started on verapamil 40 mg three times per day and her headache ceased within 24 h of initiating treatment. A repeat CT angiogram completed 4 weeks after the initial study noted resolution of the areas of vessel stenosis.

Conclusion

A case of reversible cerebral vasoconstriction syndrome developing after treatment with a calcitonin gene-related peptide monoclonal antibody is presented. The timing of the new type of headache occurring 2 days post erenumab injection suggests a possible cause and effect relationship. Reversible cerebral vasoconstriction syndrome as a possible treatment-related complication to the usage of calcitonin gene-related peptide monoclonal antibodies needs to be studied further.

中文翻译：

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注射erenumab预防偏头痛后出现可逆性脑血管收缩综合征

背景

可逆性脑血管收缩综合征通常由血管活性化合物或违禁药物引发。一种新型偏头痛预防药物利用单克隆抗体阻断降钙素基因相关肽。降钙素基因相关肽是一种有效的脑血管系统血管扩张剂。在易患可逆性脑血管收缩综合征的患者（偏头痛患者）或使用血管活性化合物的个体中，阻断降钙素基因相关肽是否会引发脑动脉血管痉挛？我们介绍了降钙素基因相关肽单克隆抗体治疗后发生的可逆性脑血管收缩综合征的病例。

案例报告

一名有发作性偏头痛病史的 43 岁女性在第二次注射 erenumab 两天后出现急性头痛伴性高潮。注射 erenumab 十天后，她在完成高强度锻炼时出现了霹雳性头痛。这些新的头痛只是左侧问题。计算机断层扫描血管造影显示涉及左侧大脑中动脉和大脑前动脉的轻度至中度狭窄区域，与可逆性脑血管收缩综合征有关。她否认接触过任何已知的可逆性脑血管收缩综合征促发药物或违禁药物。她确实赞同在 erenumab 治疗之前最近暴露于高海拔地区。她开始服用维拉帕米 40 毫克，每天 3 次，开始治疗后 24 小时内头痛停止。

结论

介绍了一例用降钙素基因相关肽单克隆抗体治疗后发生的可逆性脑血管收缩综合征。erenumab 注射后 2 天出现新型头痛的时间表明可能存在因果关系。可逆性脑血管收缩综合征作为降钙素基因相关肽单克隆抗体使用的可能治疗相关并发症需要进一步研究。