Document Type

Article

Publication Date

5-26-2026

Comments

This article is the author's final published version in International Medical Case Reports Journal, Volume 19, 2026, 596440.

The published version is available at https://doi.org/10.2147/IMCRJ.S596440. Copyright © Zeldich et al.

Abstract

Migrainous thoracalgia (MT) refers to chest pain (CP) potentially arising from a neurologic etiology, often temporally linked to migraine. We present a 57-year-old woman with chronic migraine who developed recurrent CP typically following migraine attacks. Despite multiple cardiac evaluations, including cardiac MRI and catheterizations, she was diagnosed with fibromuscular dysplasia, spontaneous coronary artery dissection, and coronary microvascular disease. Her CP partially responded to nitroglycerin and improved modestly with migraine control using ubrogepant and calcium channel blockers. During admission for refractory migraine, she received intravenous lidocaine, magnesium, ketorolac, and neuroleptics, resulting in several months of CP remission despite brief migraine relief. Longitudinal follow-up demonstrated that eptinezumab was associated with improvement in both migraine and CP symptoms. This case highlights the diagnostic challenge of MT and the overlap between migraine and coronary vasospastic or microvascular processes. The observed improvement in CP following migraine-directed therapies raises the possibility of a shared neurovascular mechanism, although causality cannot be established. Greater awareness of MT and interdisciplinary management may improve outcomes in similar patients.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License

PubMed ID

42220623

Language

English

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Neurology Commons

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