Diaphragmatic small bowel disease in a patient with resistant migraine and medication overuse treated with galcanezumab

Background: Monoclonal antibodies directed against Calcitonin Gene-Related Peptide (CGRP) or its receptor have greatly improved the quality of life of migraine patients. However, these treatments must be administered with caution in patients with constipation or inflammatory bowel disease, considering that non-steroidal anti-inflammatory drugs, widely used by patients with migraine to treat attacks, may have gastrointestinal side effects. Methods: After receiving informed consent, we obtained patient's information from her clinical documentation and archived medical records. Results: We report the case of a patient with a clinical history of migraine with and without aura, paroxysmal hemicrania, and overuse of indomethacin, who received a diagnosis of symptomatic small bowel diaphragmatic disease under prophylactic treatment with galcanezumab. Due to the intestinal implications of CGRP, we decided to discontinue this therapy and begin OnabotulinumtoxinA treatment. Conclusions: This case report recommends extreme caution when starting anti-CGRP mAbs treatment in patients with longstanding medication overuse with NSAIDs and abdominal symptoms.