Acute neuroendocrine challenge elicits enhanced cortisol response and parallel transcriptomic changes in patients with migraine

Patients with migraine without aura showed an enhanced cortisol response to a neuroendocrine challenge. This was accompanied by a probable suppression of <i>NF</i>κ<i>B</i> activity through dysregulation of <i>NKRF</i> and an altered immune function. Upregulated carbohydrate metabolism may reflect the elevated cortisol concentrations' stimulating effects on endothelial glycocalyx, playing a role in NO-induced vasodilation, a trigger for migraine attacks. The results suggest the elevated cortisol response may trigger migraine attacks through altered glycocalyx and immune functions.