Calcitonin gene-related peptide-targeting drugs efficiently treat abdominal migraine—A case report

Aim Abdominal migraine is rare in adults resulting in a lack of evidence-based treatment recommendations. Treatment therefore pragmatically follows the guidelines for migraine with and without aura. Here, we present the first report of a patient with abdominal migraine successfully treated with three different drugs targeting calcitonin gene-related peptide (CGRP). Methods A 68-year-old woman was referred to our headache center with suspected late-onset abdominal migraine. After extensive diagnostics, the diagnosis was confirmed based on the International Headache Society diagnostic criteria and guideline-compliant treatment was initiated. Results Before treatment initiation, the patient had suffered from 9 to 17 stereotypical episodes per month that lasted about 12 h and included moderate to severe abdominal pain, diarrhea, nausea, and vomiting for over 20 years. Earlier treatment comprised several acute and preventive drugs without success. Finally, she received attack treatment with rimegepant resulting in pain freedom after 2 h and preventive treatment with eptinezumab and fremanezumab resulting in 61% and 78% reduction of the attack frequency, respectively. Conclusion Calcitonin gene-related peptide is a crucial factor for the development of abdominal migraine and CGRP-targeting drugs may be a treatment option for these patients.