Anti-CGRP migraine drug may have contributed to vertebral artery dissection in first reported case | Research

The takeaway

First case report of vertebral artery dissection in a migraine patient on anti-CGRP antibody therapy, with FAERS database analysis revealing CeAD signals for CGRP-blocking drugs—raising vascular safety questions.

First CeAD on anti-CGRP drug
Vertebral artery dissection in a migraine patient on CGRP mAb raises questions about whether blocking CGRP's vascular protection increases arterial dissection risk

What the researchers found

First case: vertebral artery dissection on anti-CGRP mAb. FAERS: CeAD signals for CGRP-blocking drugs detected. CGRP: vasodilatory → removal may ↓vascular protection. Migraine independently associated with CeAD risk.

Why it matters

CGRP protects blood vessels through vasodilation. Blocking it for migraine could theoretically increase arterial dissection risk—a rare but devastating event. With millions on anti-CGRP drugs, even rare vascular events are important.

How the study worked

Case report + FAERS database disproportionality analysis for CeAD with anti-CGRP drugs.

What this study cannot tell us

Single case. Migraine itself causes CeAD risk (confounding). FAERS data is spontaneous reporting. Cannot establish causation.

How to read the evidence

Case report + FAERS analysis. Important safety signal needing epidemiological confirmation.

When this study was published

Published in 2025.

The bigger picture

This highlights the vascular trade-off of blocking CGRP: migraine relief at the possible cost of reduced vascular protection. Long-term cerebrovascular safety surveillance of anti-CGRP drugs is warranted.

Questions still open

Should patients with CeAD history avoid anti-CGRP drugs?
Does CGRP blockade increase vascular stiffness or vulnerability?
Are certain anti-CGRP drugs safer for vascular risk than others?

Common questions

Can migraine drugs cause artery dissection?

This is the first reported case where an anti-CGRP migraine drug was associated with vertebral artery dissection. Since CGRP normally protects blood vessels by keeping them dilated, blocking it could theoretically make arteries more vulnerable. However, migraine itself also increases dissection risk, making causation unclear.

Should I be worried about blood vessel problems on CGRP drugs?

This is very rare. However, if you experience sudden severe neck pain, headache unlike your usual migraines, or neurological symptoms while on anti-CGRP therapy, seek immediate medical attention. These could be signs of arterial dissection, which requires urgent treatment.

Read the original research

Vertebral artery dissection in a patient with migraine treated with calcitonin gene-related peptide monoclonal antibody: a case report and FAERS database analysis.

BMC neurology, 25(1), 1

View on PubMed ↗Publisher’s paper ↗

Citation

Tokuyasu, Daiki; Imai, Shungo; Chen, Shih-Pin; Ihara, Keiko; Watanabe, Narumi; Izawa, Yoshikane; Nakahara, Jin; Hori, Satoko; Takizawa, Tsubasa. (2025). Vertebral artery dissection in a patient with migraine treated with calcitonin gene-related peptide monoclonal antibody: a case report and FAERS database analysis.. BMC neurology, 25(1), 1. https://doi.org/10.1186/s12883-024-04009-z