Migraine and adult-onset stuttering: A proposed autoimmune phenomenon.

TO THE EDITOR: We report a case of a 40-year-old female patient with a medical history of chronic refractory urticaria who presented with intractable migraine and adult-onset stuttering. The patient’s stuttering was characterized by a sudden onset and prolonging of words with repetition of beginning syllables, and it was associated with anxiety and migraine. There was no personal or known family history of stuttering. The patient reported her stuttering began more than 2 years ago, when she was prescribed cyproheptadine, 12 mg/d, for autoimmune urticaria flares. This medication was discontinued approximately 5 months later due to weight gain and possible contribution to stuttering, but the stuttering did not improve. Multiple other treatment options had been previously explored, including propranolol, topiramate, IV steroids, dihydroergotamine, and butalbital-acetaminophen-caffeine combination medication, but these were ineffective. Magnetic resonance imaging and venography of the brain demonstrated a partially visualized left multispacial vascular malformation, but were otherwise unremarkable. Given the patient's extensive history of migraine medication failures, the patient’s neurologist administered erenumab, 70 mg, a new autoimmune treatment for migraine. Erenumab is a monoclonal antibody that antagonizes the calcitonin gene-related peptide (CGRP) receptor and is approved for use as migraine prophylaxis. The patient reported relief of migraine and stuttering within 2 days of treatment and remained free of symptoms for 1 month. The stuttering returned by the time of the next erenumab dose, which the patient had delayed to better understand the treatment’s effects on her migraine and stuttering. After the second dose of erenumab was administered, she again experienced improvements in both the prevention of her migraine and treatment of her stuttering symptoms.