Coronary Vasospasm During Combined Calcitonin Gene‐Related Peptide Receptor Antibody and β‐Blocker Therapy for Migraine

ABSTRACT A 45‐year‐old woman with refractory migraine developed severe coronary vasospasm during combination therapy with erenumab and propranolol. She presented with recurrent chest pain radiating to the jaw associated with diaphoresis, relieved by nitroglycerin. Coronary angiography showed no significant organic stenosis; however, an acetylcholine provocation test induced diffuse severe vasospasm in the left anterior descending and circumflex arteries. Propranolol was discontinued, and a calcium channel blocker was started, allowing for the safe continuation of erenumab. For acute migraine treatment, triptans were avoided, with lasmiditan used as a non‐vasoconstrictive alternative. This case highlights the potential relevance of vasospastic susceptibility during combined calcitonin gene‐related peptide pathway inhibition and non‐selective β‐blockade. Careful pharmacological adjustment, including replacement of β‐blockers with calcium channel blockers and the avoidance of vasoconstrictive agents such as triptans, may allow the continued use of calcitonin gene‐related peptide monoclonal antibodies in selected patients with vasospastic disorders.