Can Tinnitus Cause Migraines?
Tinnitus does not cause migraines, but the two conditions frequently coexist and share common underlying neurological mechanisms, with migraine potentially exacerbating tinnitus symptoms rather than the reverse. 1
Understanding the Relationship
The relationship between tinnitus and migraine is bidirectional but asymmetric—migraine appears to influence tinnitus more than tinnitus influences migraine:
- Up to 45% of tinnitus patients concomitantly suffer from migraine, indicating a strong association between these conditions 1
- Migraine patients have a high prevalence of cochlear symptoms including tinnitus, suggesting migraine affects auditory pathways 1
- Both conditions stem from central nervous system disturbances involving disruption of auditory and trigeminal nerve pathways 1
Neurological Mechanisms Linking the Conditions
The connection between these conditions involves specific brain pathways:
- Trigeminal nerve activation of the auditory cortex during migraine attacks can modulate sound sensitivity, resulting in tinnitus fluctuation in some patients 1
- Increased brain and inner ear vascular permeability from trigeminal nerve inflammation can cause both headache and auditory symptoms 1
- Migraine comorbid with tinnitus shows decreased cerebral blood flow in the right superior temporal gyrus and middle frontal gyrus, with migraine severity negatively correlating with cerebral blood flow 2
- Aberrant cerebellar-cortical connectivity occurs in migraine patients with tinnitus, representing a transient pathologic state 3
Shared Triggers and Features
Both conditions share common precipitating factors that can worsen either or both:
- Stress, sleep disturbances, and dietary factors trigger both tinnitus and migraine 1
- Noise exposure, traumatic brain injury, anxiety, and depression are correlated with both conditions 4
Clinical Assessment Priorities
When evaluating patients with both tinnitus and headache:
- Determine if the patient meets diagnostic criteria for vestibular migraine, as this is a common cause of dizziness that can closely mimic other conditions and requires appropriate assessment for optimal treatment 5
- Inquire about headache symptoms during tinnitus evaluation, as the presence of headaches may indicate a more complex clinical picture 6
- Assess for warning signs: new-onset severe headache with tinnitus, pulsatile tinnitus, and tinnitus with focal neurological deficits warrant further investigation 6
- Screen for psychiatric comorbidity: patients with tinnitus and severe anxiety or depression require prompt identification and intervention, as suicide has been reported in tinnitus patients with coexisting psychiatric illness 5, 6
Treatment Implications
The shared mechanisms suggest treatment approaches:
- Migraine therapies show promising results for treatment of tinnitus in patients with both conditions 1
- Flunarizine or topiramate can be effective for specific tinnitus presentations associated with migraine, particularly "clocking tinnitus" (staccato tinnitus simulating clock ticking sounds) 7
- Cognitive Behavioral Therapy has the strongest evidence for improving quality of life in patients with persistent tinnitus 8
Important Clinical Caveat
Do not confuse causation with association—while migraine can exacerbate tinnitus through shared neurological pathways, tinnitus itself does not cause migraine headaches. The relationship is one of comorbidity with migraine potentially worsening tinnitus perception, not tinnitus triggering migraine attacks. 1, 2