"Tinnitus and migraines are a bit like the chicken and the egg. Which comes first? I always try to get the patient to control their migraine first, and usually the tinnitus then subsides." - Drew Sutton, MD, Board-Certified Otolaryngologist
You've probably experienced a migraine at some point. Migraines are characterized by a particularly painful headache, which may be accompanied by other symptoms in addition to throbbing in the skull. Nausea, light sensitivity, noise sensitivity, and even blurred vision can accompany a migraine.
One symptom seems particularly associated with migraines: tinnitus. Tinnitus is characterized by the perception of a whistling or buzzing sound in the ears, with no external sound source. This phantom sound has the power to make an already distressing experience even more unpleasant.
Here's an in-depth look at tinnitus and migraines, how they might be related, and the ways you can fight them.
What is tinnitus?
Tinnitus is traditionally described as a phantom ringing in the ears, but in reality, tinnitus can sound very different from person to person.
For some, tinnitus takes the form of a high-pitched sound; for others, it's more like a whoosh. The variety of sounds perceived is immense, but they all have one thing in common: they are phantom sounds that those around you don't hear.
Beyond the tone, the frequency of tinnitus can also vary. For example, a form of tinnitus called pulsatile tinnitus occurs in rhythmic pulsations, while other tinnitus is permanent and constant. Some tinnitus is accompanied by another disorder, such as hearing loss, while others occur seemingly for no reason.
There are two main categories of tinnitus: subjective tinnitus and objective tinnitus. Each type has its own causes and presentation. Here's a more detailed look at the types of tinnitus and their possible causes.
Subjective tinnitus
Subjective tinnitus is considered the most common form. It is only perceptible to the affected person and appears to have no apparent physical cause.
In the absence of a physical stimulus, subjective tinnitus is believed to originate in the brain, specifically in the auditory cortex.
Subjective tinnitus can appear without other associated pathologies, but it often goes hand in hand with hearing loss. This is thought to be due to a mechanism comparable to phantom limb pain.
It is hypothesized that when hearing loss sets in, the auditory cortex seeks to increase its sensitivity to sound signals. In the case of tinnitus, this sensitivity would be pushed so far that the brain eventually interprets the absence of an auditory signal as a precise tone, giving rise to tinnitus.
Objective tinnitus
Unlike subjective tinnitus, objective tinnitus comes from actual signals sent from the ear to the brain. Where subjective tinnitus is primarily neurological in origin, objective tinnitus results from a physical stimulus acting on the ear.
One form of objective tinnitus is pulsatile tinnitus, which results in a rhythmic sound, similar to pulsations. This rhythm is usually caused by more turbulent blood flow near the sensory organs of the ear. The ears pick up this turbulence as sound, hence pulsatile tinnitus.
Another form of objective tinnitus can result from muscle spasms in or around the ear. The ear houses tiny muscles, and many others surround it. Muscle spasms can interfere with the sensory elements of the ear and send involuntary sound signals to the brain.
Tinnitus treatments
Whatever their forms, all tinnitus results in an unwelcome sound. Some can be treated once the underlying cause is resolved, but often tinnitus remains incurable, leaving sufferers frustrated, annoyed, and seeking relief.
There are several treatments for tinnitus, many of which aim to reduce its impact on your overall well-being. Therapies and other techniques have shown usefulness for people suffering from tinnitus.
One of the most common approaches is therapy. Both cognitive-behavioral therapy and tinnitus retraining therapy (TRT) can be used. Both methods seek to improve your relationship with tinnitus by teaching you to manage it effectively and to train your body to no longer perceive it negatively.
These approaches can be a great help for people with severe tinnitus, who are unable to carry out their daily lives due to the pervasive discomfort.
Another widely used technique for short-term relief is sound masking. Sound masking has many uses, but its main purpose is to cover unwanted ambient noises.
Sound masking is best known in the form of white noise: many parents today use white noise generators to help their children nap more easily when the house is busy.
In the case of tinnitus, sound masking can be an effective way to drown it out and provide you with relief. One of the frequent difficulties for sufferers is difficulty falling asleep. Sound masking could be exactly what you need for quick relief and to fall asleep.
Migraines
Migraines can ruin an entire day. With intense head pain, it's hard to focus on anything else. A migraine is already challenging enough, but some people suffer from more complex migraines, accompanied by a multitude of other symptoms.
Common symptoms include light sensitivity, noise sensitivity, and tinnitus. In complex migraines, patients may experience stroke-like symptoms as well as a particular sensation called an aura. Here's an overview of the main types of migraines. There are nine different ones; we focus here on the most frequent forms.
Common migraine
Common migraine is the most prevalent form. It comes with the usual migraine symptoms: fatigue, increased sensitivity of the different senses, and head pain.
General recommendations for a common migraine include taking over-the-counter pain relievers and resting in a dark, quiet room.
Migraine with aura
Migraine with aura is distinguished by the fact that the person feels the migraine coming long before the pain actually sets in. The migraine unfolds in four distinct phases.
People prone to migraines with aura are those who experience the preliminary phases of the attack. These warning symptoms can appear several hours in advance and include possible visual disturbances, difficulty concentrating, a feeling of general malaise, and tinnitus.
The link between migraines and tinnitus
The link between tinnitus and migraines is unique; it is well documented, but much remains to be discovered. Migraines and tinnitus have a close relationship, with a high comorbidity rate: many people suffer from both simultaneously.
Many researchers have attempted to elucidate the underlying mechanism for this strong comorbidity. Is it tinnitus that triggers the headache, or does the headache increase sensitivity to pre-existing tinnitus?
A 2015 study of 489 participants with both disorders showed that headaches appear to precede bothersome tinnitus, and not the other way around. This result indicates that a migraine can, to some extent, worsen the perception of tinnitus and make it more severe.
While this finding is enlightening, it is also known that tinnitus can be part of the migraine aura. This contradiction illustrates the complexity of the links between tinnitus and migraines.
The best treatment
The best way to treat tinnitus and migraines is to mitigate the migraine as much as possible. A migraine can be painful and increase your sensitivity to many stimuli, including tinnitus, making it worse.
Taking an over-the-counter pain reliever is an excellent first-line treatment; if this is not enough or if the migraine becomes unmanageable, it may be necessary to consult a healthcare professional. Migraines can sometimes be extremely complex, and a doctor will be better equipped to manage them.
Conclusion
In summary, tinnitus and migraines are two distinct problems, but they appear to be linked within the body. While the extent and mechanism of this relationship remain poorly understood, the comorbidity of the two conditions is well established.
Understanding the ins and outs of tinnitus and migraines allows you to better grasp their particular relationship and gives you leads to manage or treat them effectively. Acting on one as well as the other contributes to your general well-being.
Sources:
Tinnitus and Headaches | NCBI
Migraines: Causes, Treatment & Symptoms | Cleveland Clinic
Migraine - Diagnosis and treatment | Mayo Clinic
