A 79-year-old male with history including migraines and C3 AIS C quadriplegia secondary to a fall with C4 vertebral fracture experienced insidious onset, progressive upper extremity NP following his injury. The quality of pain was electrical and burning, described as “grabbing an electric wire fence.” Severe associated allodynia and hyperalgesia limited the patient’s ability to tolerate nursing cares (i.e. repositioning, turns, bathing), and therapy modalities (i.e. range of motion, electrical stimulation). MRI of the cervical spine ruled out syringomyelia. The patient was treated with scheduled acetaminophen, pregabalin, and duloxetine. Numerous opioid analgesic regimens were trialed (including oxycodone, tramadol, hydromorphone, and topical buprenorphine), either without significant analgesia or with significant sedation. Given the patient’s history of migraines, erenumab, a once monthly injectable CGRPi, was started.