Case Report: A reversible autonomic-endothelial migraine pattern: a conceptual perspective illustrated by a clinical case.

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 mg and (perindopril 5 mg/indapamide 1.25 mg/amlodipine 5 mg) once daily for mild hypertension. Attacks occurred 3-4 times per month-often on Saturdays-were 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 per se. 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.