Preventive CGRP ligand monoclonal antibody therapy in refractory adult-onset migraine- associated cyclic vomiting syndrome

Cyclic vomiting syndrome (CVS) is a disorder of gut–brain interaction frequently associated with migraine, suggesting overlapping neurobiological mechanisms. However, therapeutic options remain limited in refractory adult patients. Calcitonin gene-related peptide (CGRP) plays a central role in migraine pathophysiology and is also involved in visceral sensory processing, nausea, and autonomic regulation, supporting a potential therapeutic role for CGRP-targeted therapies in selected CVS phenotypes. We report a 51-year-old woman with adult-onset migraine-associated CVS refractory to multiple preventive therapies, including amitriptyline, venlafaxine, and topiramate. Preventive treatment with the CGRP ligand monoclonal antibody fremanezumab resulted in a marked reduction in migraine frequency and substantial improvement in vomiting severity and frequency, with significant functional recovery over six months of follow-up. This observation supports the hypothesis that CGRP modulation may benefit selected patients with migraine-associated CVS and highlights the need for further systematic evaluation of CGRP-targeted therapies in disorders of gut–brain interaction.