Tinnitus Does Not Cause Migraine Headaches
Tinnitus does not cause migraine headaches; rather, both conditions frequently co-occur and may share common underlying pathophysiological mechanisms, particularly involving central nervous system dysfunction and trigeminal-auditory pathway interactions. 1
Understanding the Relationship
The relationship between tinnitus and migraine is one of association and shared pathophysiology, not causation:
Migraine can exacerbate pre-existing tinnitus through trigeminal nerve activation of the auditory cortex during migraine attacks, resulting in tinnitus fluctuation in some patients. 1
Up to 45% of tinnitus patients concomitantly suffer from migraine, suggesting a significant bidirectional relationship rather than a causal one. 1
Both conditions stem from central nervous system disturbances involving disruption of auditory and trigeminal nerve pathways, which explains their frequent co-occurrence. 1
Clinical Evidence of Association
The evidence demonstrates clear patterns of co-occurrence rather than causation:
Headache laterality is significantly related to tinnitus laterality, and in the majority of patients, fluctuations in symptom severity of tinnitus and headache are interrelated, arguing against purely coincidental co-occurrence. 2
Patients with severe tinnitus have a 40% prevalence of headaches, compared to 26% in those with any tinnitus, suggesting that headaches may contribute to tinnitus distress rather than the reverse. 3
Headache is significantly associated with tinnitus as a big problem (odds ratio 5.63) and severe tinnitus (odds ratio 4.99), but this represents correlation, not causation. 3
Shared Pathophysiological Mechanisms
Understanding the biological basis helps clarify why these conditions co-occur:
Trigeminal nerve inflammation increases brain and inner ear vascular permeability, which can cause both headache and auditory symptoms simultaneously. 1
Central sensitization develops in most migraineurs during attacks, and tinnitus intensity increase may represent an allodynic symptom related to this central sensitization or cortical hyperexcitability. 4
Both conditions share common triggers including stress, sleep disturbances, and dietary factors, which may explain why they fluctuate together. 1
Distinguishing Vestibular Migraine
When evaluating patients with both tinnitus and headache, consider vestibular migraine:
Vestibular migraine can present with auditory symptoms including tinnitus, but hearing loss in vestibular migraine is typically mild or absent and stable over time, unlike Ménière's disease. 5
Auditory complaints in migraine are often bilateral, which helps differentiate from other causes of tinnitus. 5
The International Headache Society officially listed vestibular migraine as an episodic migraine syndrome in 2018, recognizing that migraine can cause vestibular and auditory symptoms. 6
Clinical Approach
When encountering patients with both tinnitus and headache:
Evaluate for migraine diagnostic criteria including at least 5 attacks lasting 4-72 hours with characteristic features (unilateral location, pulsating quality, moderate-to-severe intensity, aggravation by activity) plus nausea/vomiting or photophobia/phonophobia. 5
Assess temporal relationships: Does tinnitus worsen during headache attacks? This suggests shared pathophysiology rather than causation. 4
Consider migraine therapies for tinnitus management in patients with both conditions, as promising results have been reported given their shared pathophysiological mechanisms. 1
Audiological examination is recommended for patients with unilateral persistent tinnitus or hearing problems to rule out other causes. 5
Important Caveats
Imaging is not routinely indicated for bilateral, nonpulsatile tinnitus without focal neurological abnormalities or asymmetric hearing loss. 5
The emotional impact should not be underestimated, as patients often struggle with both incapacitating tinnitus and headaches, requiring appropriate counseling about expectations. 5
Anxiety, depression, and psychological disturbances may need prompt identification and intervention in patients with severe tinnitus and headache. 5