ArticleBMC neurology2026
CGRP-pathway exposure during the pre-EBP interval in spontaneous intracranial hypotension: an exploratory retrospective case series.
Article in BMC neurology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Abstract
backgroundGiven hypothesized involvement of calcitonin gene-related peptide (CGRP) in trigeminovascular pain and the frequent migrainous features of spontaneous intracranial hypotension (SIH), we describe temporal associations between initiation of CGRP-pathway therapies and short-term symptom changes during the interval before image-guided epidural blood patch (pre-EBP) in seven consecutively managed SIH patients. Because this is a small retrospective uncontrolled series, we report exploratory observations only. CASE PRESENTATION: Work-up included selective head-up tilt testing and heavily T2-weighted MR myelography demonstrating predominantly cervicothoracic and/or multifocal spinal CSF leaks. During the pre-EBP interval patients received CGRP-pathway agents: monoclonal antibodies (fremanezumab n = 1; galcanezumab n = 3) and/or gepants (atogepant n = 4; rimegepant PRN n = 1). Five of seven patients (71%) met a pre-specified rubric of clinically meaningful improvement documented after CGRP initiation; in all seven patients with routinely charted Numeric Rating Scale (NRS, 0-10) scores the median NRS reduction was 3 points (range 1-4). Positional orthostatic features commonly persisted until after EBP. Median interval from CGRP initiation to targeted EBP was 7 days. In this small cohort we did not observe an obvious signal that pre-EBP CGRP exposure impaired subsequent clinical response to EBP; however, the sample size and short follow-up preclude conclusions about rare or delayed interactions.
conclusionsThese observations are hypothesis-generating only and report temporal associations between CGRP-pathway initiation and short-term symptom changes in a highly selected cohort with comorbid chronic migraine. They do not demonstrate efficacy for SIH and should not be interpreted as endorsing CGRP-pathway therapy as a treatment for SIH. Prospective, controlled trials with validated headache and orthostatic endpoints, stratification by migraine status, and peripheral/CSF biomarker assessments are required.
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