Can Tinnitus Cause Migraines?
No, tinnitus does not cause migraines—the relationship flows in the opposite direction: migraine can cause or exacerbate tinnitus through shared neurological pathways involving trigeminal nerve activation and central nervous system dysfunction. 1, 2
Understanding the Directional Relationship
Migraine is recognized as a cause of auditory symptoms including tinnitus, not the reverse. The American Academy of Otolaryngology-Head and Neck Surgery guidelines explicitly state that clinicians should assess for vestibular migraine when evaluating patients with auditory complaints, noting that "persons who are subject to migraine often present symptoms analogous to those which we have described," including tinnitus and hearing-related complaints. 1
Key Mechanistic Evidence
Migraine can trigger tinnitus fluctuation through trigeminal nerve modulation of the auditory cortex during migraine attacks, with up to 45% of tinnitus patients concomitantly suffering from migraine. 2
Both conditions stem from central nervous system disturbances involving disruption of auditory and trigeminal nerve pathways, not from tinnitus causing headache. 2
Increased brain and inner ear vascular permeability from trigeminal nerve inflammation during migraine can produce both headache and auditory symptoms simultaneously. 2
Clinical Presentation Patterns
When tinnitus and migraine coexist, the tinnitus typically worsens during migraine attacks rather than preceding or triggering them. 3
Tinnitus intensity consistently increases during headache attacks in migraine patients, representing an allodynic symptom related to central sensitization or cortical hyperexcitability during the migraine episode. 3
Migraine patients with tinnitus exhibit decreased cerebral blood flow in the auditory cortex and prefrontal regions, with migraine severity correlating negatively with cerebral blood flow—demonstrating that migraine pathophysiology drives the tinnitus changes. 4
Aberrant cerebellar-cortical connectivity patterns in migraine patients with tinnitus show transient pathologic states during migraine attacks, further supporting migraine as the primary driver. 5
Critical Diagnostic Distinctions
In migraine, "hearing loss" may be a perception of difficulty processing sound rather than true hearing loss, and auditory complaints are often bilateral—distinguishing it from other causes of tinnitus. 1
Visual auras, motion intolerance, and light sensitivities in migraine help differentiate vestibular migraine from Ménière's disease, both of which can present with tinnitus. 1
Clinicians should inquire about vertigo triggers including light sensitivity and motion intolerance, as well as prior or ongoing treatments for migraine when evaluating tinnitus patients. 1
Therapeutic Implications Supporting This Direction
Treatment of migraine can abolish or significantly reduce tinnitus, providing strong evidence that migraine drives tinnitus rather than vice versa. 6
Onabotulinumtoxin A injections for chronic migraine abolished tinnitus completely in 2 of 5 patients with pre-existing tinnitus, including one patient whose 10-year tinnitus resolved permanently with one treatment. 6
Tinnitus loudness was attenuated 70-100% for approximately three months in the remaining patients, paralleling their headache response—demonstrating that controlling migraine controls the tinnitus. 6
All patients who experienced tinnitus improvement had significant improvement of their chronic migraine, while none of the migraine non-responders reported tinnitus changes. 6
Common Clinical Pitfalls
Do not dismiss tinnitus in migraine patients as unrelated or purely psychological—it represents a genuine neurological manifestation of the migraine pathophysiology requiring integrated treatment. 7, 2
Failing to recognize that tinnitus and migraine share symptom triggers (stress, sleep disturbances, dietary factors) can lead to missed opportunities for comprehensive management addressing both conditions simultaneously. 2
New-onset severe headache with tinnitus, or pulsatile tinnitus with headache, requires urgent imaging evaluation to exclude life-threatening vascular causes such as dural arteriovenous fistulas or arterial dissection, which can present with both symptoms. 8, 7
Patients with tinnitus and migraine who develop severe anxiety or depression require prompt identification and intervention due to increased suicide risk. 7, 9