Intraparenchymal cerebral hemorrhage in a patient undergoing treatment with galcanezumab: the importance of adequate blood pressure control

Background: Calcitonin gene-related peptide (CGRP) is a neuropeptide involved in pain transmission and modulation, and implicated in migraine pathophysiology. Due to the vasodilatory action of CGRP, anti-CGRP drugs, while ameliorating migraine, may increase hypertension, a major risk factor for cerebrovascular diseases. Although most studies support the safety of this class of drugs, the use of anti-CGRP drugs in some individuals has been associated with elevated blood pressure. Case Presentation: We report a case of a cerebral hemorrhage in a patient treated with an anti-CGRP monoclonal antibody and a poorly controlled blood pressure. Discussion: Migraine is associated with increased cerebrovascular risk and hypertension, and anti-CGRP therapies could potentially contribute to acute hypertensive episodes, possibly increasing the risk of complications, including cerebral hemorrhage, in vulnerable individuals. Conclusions: Limited evidence links anti-CGRP therapies to hypertension. Pending additional data, caution is recommended when prescribing these drugs, especially in patients with cardiovascular risk factors.