{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T06:12:37Z","timestamp":1776147157637,"version":"3.50.1"},"reference-count":53,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T00:00:00Z","timestamp":1776124800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pain Res."],"abstract":"<jats:p>\n                    Migraine is commonly regarded as a primary neurovascular disorder; however, systemic endothelial and autonomic factors may modulate its expression and course. A 41-year-old male with a 10-year history of migraine without aura and vasomotor rhinitis experienced sustained remission after initiation of nebivolol 5\u2005mg and (perindopril 5\u2005mg\/indapamide 1.25\u2005mg\/amlodipine 5\u2005mg) once daily for mild hypertension. Attacks occurred 3\u20134 times per month\u2014often on Saturdays\u2014were triggered by strong odors such as perfume, and occasionally accompanied by nausea or vomiting. Headaches fulfilled ICHD-3 criteria for migraine without aura and initially responded to triptans. Within two weeks of therapy, blood pressure normalized and both migraine and nasal symptoms resolved. Remission persisted for 12 months. The temporal sequence and clinical pattern appear consistent with a clinical improvement that may involve endothelial and autonomic modulation, among several plausible contributors, including combined antihypertensive therapy. The patient's blood pressure remained within the physiological range throughout the observation period, indicating that the sustained remission extended beyond antihypertensive control\n                    <jats:italic>per se<\/jats:italic>\n                    . This case illustrates a hypothesis-generating clinical pattern potentially involving endothelial and autonomic modulation and highlights how vascular homeostasis and circadian autonomic factors may influence migraine chronification and remission.\n                  <\/jats:p>","DOI":"10.3389\/fpain.2026.1748356","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T05:36:59Z","timestamp":1776145019000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: A reversible autonomic\u2013endothelial migraine pattern: a conceptual perspective illustrated by a clinical case"],"prefix":"10.3389","volume":"7","author":[{"given":"Vlodeks","family":"Gromakovskis","sequence":"first","affiliation":[{"name":"Pain Medicine Unit, Neurology Department, Association of Health Centers (Vesel\u012bbas Centru Apvien\u012bba, VCA)","place":["Riga, Latvia"]},{"name":"Independent Pain Medicine Researcher","place":["Riga, Latvia"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1046\/j.1468-2982.2002.00310.x","article-title":"CGRP may play a causative role in migraine","volume":"22","author":"Lassen","year":"2002","journal-title":"Cephalalgia"},{"key":"B2","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1046\/j.1468-2982.1995.015002094.x","article-title":"The nitric oxide hypothesis of migraine and other vascular headaches","volume":"15","author":"Olesen","year":"1995","journal-title":"Cephalalgia"},{"key":"B3","doi-asserted-by":"publisher","first-page":"823","DOI":"10.1177\/0333102416653232","article-title":"Relationship between serum levels of VIP, but not of CGRP, and cranial autonomic parasympathetic symptoms: a study in chronic migraine patients","volume":"37","author":"Riesco","year":"2017","journal-title":"Cephalalgia"},{"key":"B4","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1177\/0333102414535111","article-title":"Increased vip levels in peripheral blood outside migraine attacks as a potential biomarker of cranial parasympathetic activation in chronic migraine","volume":"35","author":"Cernuda-Moroll\u00f3n","year":"2014","journal-title":"Cephalalgia"},{"key":"B5","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1177\/0333102415593087","article-title":"Prevalence of cranial autonomic parasympathetic symptoms in chronic migraine: usefulness of a new scale","volume":"36","author":"Riesco","year":"2016","journal-title":"Cephalalgia"},{"key":"B6","doi-asserted-by":"publisher","first-page":"366","DOI":"10.3389\/fnhum.2016.00366","article-title":"Increased functional activation of limbic brain regions during negative emotional processing in migraine","volume":"10","author":"Wilcox","year":"2016","journal-title":"Front Hum Neurosci"},{"key":"B7","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1111\/j.1468-2982.2009.01964.x","article-title":"Increased nitric oxide stress is associated with migraine","volume":"30","author":"Gruber","year":"2010","journal-title":"Cephalalgia"},{"key":"B8","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1007\/s10194-011-0323-7","article-title":"Increased asymmetric dimethylarginine and nitric oxide levels in patients with migraine","volume":"12","author":"Uzar","year":"2011","journal-title":"J Headache Pain"},{"key":"B9","doi-asserted-by":"publisher","first-page":"164","DOI":"10.3988\/jcn.2021.17.2.164","article-title":"The role of endothelial dysfunction in the pathophysiology and cerebrovascular effects of migraine: a narrative review","volume":"17","author":"Paolucci","year":"2021","journal-title":"J Clin Neurol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1212\/wnl.0b013e31826170ce","article-title":"Endothelial progenitor cells","volume":"79","author":"Rodr\u00edguez-Osorio","year":"2012","journal-title":"Neurology"},{"key":"B11","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1681\/ASN.0000000591","article-title":"Autonomic dysfunction and inflammation in CKD: a high-risk pathway","volume":"36","author":"Zoccali","year":"2025","journal-title":"J Am Soc Nephrol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1111\/j.1526-4610.1992.hed3201010.x","article-title":"Evidence for instability of the autonomic nervous system in patients with migraine headache","volume":"32","author":"Appel","year":"1992","journal-title":"Headache"},{"key":"B13","doi-asserted-by":"publisher","first-page":"62","DOI":"10.33454\/1728-1261-2021-2-62-65","article-title":"Migraine: comorbidity of arterial hypertension. 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