diff --git a/supabase/migrations/20250923162326_analysis_response_elements_fix.sql b/supabase/migrations/20250923162326_analysis_response_elements_fix.sql
new file mode 100644
index 0000000..cd82c5b
--- /dev/null
+++ b/supabase/migrations/20250923162326_analysis_response_elements_fix.sql
@@ -0,0 +1,9 @@
+-- Drop existing constraint and index for analysis_response_elements
+DROP INDEX IF EXISTS "medreport"."analysis_response_elements_unique_by_response_and_element";
+ALTER TABLE "medreport"."analysis_response_elements" 
+DROP CONSTRAINT IF EXISTS "analysis_response_elements_unique_by_response_and_element";
+
+-- Create proper unique constraint that works with ON CONFLICT
+ALTER TABLE "medreport"."analysis_response_elements" 
+ADD CONSTRAINT "analysis_response_elements_unique_by_response_and_element" 
+UNIQUE ("analysis_response_id", "analysis_element_original_id");