From the Guidelines
Tinnitus and headaches can be related to various underlying conditions, and a thorough evaluation by a healthcare provider is necessary to determine the cause and appropriate treatment. The connection between tinnitus and headaches can be complex, involving shared neural pathways or resulting from underlying conditions like migraines, temporomandibular joint disorder, or high blood pressure 1. According to the American Academy of Otolaryngology and Head and Neck Surgery Foundation (AAO-HNS) guidelines, a targeted history and clinical examination are recommended as the initial evaluation for tinnitus, followed by a prompt and comprehensive audiological examination in patients with hearing problems or unilateral persistent tinnitus 1. Some key points to consider in the evaluation of tinnitus and headaches include:
- Classifying tinnitus as pulsatile or nonpulsatile to optimize the imaging workup 1
- Identifying associated symptoms such as hearing loss, vertigo, previous head trauma, and neurological deficits 1
- Using the ACR Appropriateness Criteria topics for “Hearing Loss and/or Vertigo”, “Head Trauma”, and “Cerebrovascular Diseases-Aneurysm, Vascular Malformation, and Subarachnoid Hemorrhage” to guide imaging in specific settings 1
- Considering lifestyle modifications such as stress reduction techniques, regular sleep patterns, avoiding caffeine and alcohol, and using white noise machines for tinnitus 1 A comprehensive evaluation and targeted treatment approach can help improve outcomes and quality of life for patients experiencing tinnitus and headaches. In terms of specific treatments, medications such as low-dose antidepressants, anticonvulsants, or benzodiazepines may be used for tinnitus, while NSAIDs like ibuprofen or naproxen may be used for headaches 1. However, it is essential to consult a healthcare provider to determine the best course of treatment for individual cases. Tracking symptoms in a diary can also help identify triggers and patterns to better manage both conditions 1. Ultimately, a thorough evaluation and personalized treatment approach can help alleviate symptoms and improve quality of life for patients experiencing tinnitus and headaches.
From the Research
Causes of Tinnitus and Headache
- Tinnitus is the sensation of hearing a sound in the absence of an internal or external source and is a common problem encountered in primary care, with most cases being benign and idiopathic, and strongly associated with sensorineural hearing loss 2.
- Tinnitus can be caused by various factors, including age, hearing loss, noise exposure, inflammatory diseases or tumors of the ear, ototoxic drugs, head or cervical vertebra trauma, and psychological disorders such as anxiety and depression 3.
- Headache can be related to tinnitus, with studies suggesting that central sensitization develops in most migraneurs during the course of a migraine attack, and tinnitus intensity may increase during headache attacks 4.
- The prevalence of headache in tinnitus patients is high, with a study finding that 49.3% of tinnitus patients were diagnosed with headache, most commonly tension-type headache or migraine 5.
Relationship between Tinnitus and Headache
- Tinnitus and headache can co-occur, with headaches impacting tinnitus on many different levels and may be an important co-factor for tinnitus subtyping 5.
- Younger age, female gender, higher tinnitus burden, and coexistence of hearing loss were found to be independent variables connected with the occurrence of headache in the tinnitus group 5.
- Tinnitus can be a symptom of various disorders, including neurological disorders, and can induce psychological conditions such as insomnia, problems with concentration, and major depression symptoms 6.
Diagnosis and Treatment
- A comprehensive audiologic evaluation should be performed for patients who experience unilateral tinnitus, tinnitus that has been present for six months or longer, or that is accompanied by hearing problems 2.
- Cognitive behavior therapy is the only treatment that has been shown to improve quality of life in patients with tinnitus, while sound therapy and tinnitus retraining therapy are treatment options, but evidence is inconclusive 2.
- Counseling, psychotherapy, pharmacological approaches, masking devices, individualized sound stimulation, and cognitive behavioral therapy are the most widely used strategies for treating tinnitus, with cognitive behavioral therapy being the only treatment with a definite improvement effect on tinnitus in a large randomized controlled trial 3.