Recent studies have indicated that atypical migraines can affect tinnitus in certain individuals. Some patients experience notable improvement in tinnitus with migraine-specific treatments. But how can one determine if migraines contribute to their tinnitus, and which therapies may be beneficial?
**Comprehending migraine beyond headaches**
Migraine is a multifaceted neurological condition, not merely a severe headache. Some individuals experience migraines without ever having a headache. It is believed that genetic variations in neuronal ion channels render the brains of migraineurs more sensitive to triggers such as stress, changes in sleep patterns, hormonal fluctuations, specific foods, and sensory overload. These triggers may elevate certain brain activities beyond a specific threshold, resulting in abnormal electrical activity and activating the trigeminal nerve, which conveys sensations to the face, ears, jaw, and meninges. These alterations present as a migraine episode.
During migraine episodes, the activation of the trigeminal nerve leads to the release of chemical mediators that induce inflammation and modify blood flow in the brain. While headaches are prevalent, symptoms may also encompass nausea, sensitivity to light and sound, dizziness, and ear-related issues.
For individuals predisposed to migraines, the frequency of their episodes can differ widely based on their dietary habits, sleep quality, hormonal fluctuations, and stress levels, as all these aspects can drive brain activity beyond one’s personal migraine threshold. “If this has a genetic basis, then you maintain this susceptibility throughout your life. The triggers that lead to migraine activity could vary from one stage of your life to another,” states Dr. Michael Teixido, a neurotologist in Delaware with academic positions at both the University of Pennsylvania and Thomas Jefferson University, who has extensively discussed the head and neck effects of migraines. Some individuals may experience migraine episodes several times a week, while others might go decades without a single occurrence.
Moreover, a person’s migraine symptoms can shift throughout their lifetime. Some may experience classic headaches in their youth, which can later transform into atypical symptoms, such as ear pressure, dizziness/vertigo, and variable tinnitus.
**The correlation between migraine and tinnitus**
But how do migraines and tinnitus connect? Clinical research indicates that 26-47 percent of those with tinnitus also report migraines, while around 35 percent of migraine sufferers experience tinnitus. Additionally, as stated earlier, the trigeminal nerve becomes activated during migraine events. It has been noted that trigeminal nerve fibers innervate the inner ear’s blood vessels, leading to the hypothesis that during migraine occurrences, neurogenic inflammation or blood flow variations may directly impact the cochlea, initiating ear symptoms such as tinnitus. Migraineurs also show interictal variations between episodes, including diminished habituation (difficulty filtering out irrelevant stimuli) and sensory hypersensitivity, both pertinent to tinnitus. “A crucial element of migraine is its amplification of sensory hypersensitivity. Tinnitus itself results from hyperactive auditory neurons in the brain. Hence, when the migraine process is in play, it cranks up the existing hyperactivity of the hearing nerve, boosting the tinnitus signal,” explains Dr. Hamid Djalilian, a professor of otolaryngology and neurosurgery at the University of California Irvine who has published numerous studies and a book on the matter. Shared dietary/environmental triggers, increased sympathetic nervous system activity, altered brainstem and thalamic processing, and tension in facial, jaw, and neck muscles further intertwine the two conditions.
**Identifying migraine-related tinnitus**
Most individuals with classic nonpulsatile tinnitus associated with hearing loss (unaffected by migraines) describe a generally steady sound that may become more apparent in quiet settings, but otherwise does not significantly change over time. In contrast, tinnitus associated with migraines often displays considerable fluctuations over a typical week. It may intensify with stress, disrupted sleep, exposure to loud noise, or weather changes. Additional indicators include ear pressure or pain, dizziness, vertigo, fluctuating hearing, sensitivity to sounds, tension in the neck or jaw, and a personal or family history of migraines. “Migraine is fundamentally a disorder of sensory processing. With migraine headaches, the sensory symptom is pain. With vestibular migraine, it’s vertigo. With migraine tinnitus, it’s loud ringing,” clarifies Dr. Djalilian.
**Migraine treatment may alleviate tinnitus.**
Otolaryngologists and neurologists are noticing that addressing migraines directly can alleviate the severity of tinnitus. The treatment strategies for migraines generally fall into three categories: avoiding/minimizing migraine triggers, utilizing nutritional supplements, and administering medications. “We aim to lower the brain activity below the threshold: We elevate the threshold with medications. We reduce that brain activity through lifestyle adjustments,” remarks Dr. Djalilian.
**1. Avoidance or minimization of triggers**
Common triggers for migraines include:
– Stress (physical or emotional)
– Hormonal alterations (menstrual cycle, menopause, pregnancy, and hormone therapy)
– Sleep disruptions (excessive, insufficient, or interrupted)
– Diet