Question: I often experience ringing in my ears. Is this due to my migraines?
Tinnitus is the sensation of sound when there is no external sound. Many people have experienced this at one point in their lives as a “ringing” or “whooshing” noise. It is most commonly attributed to cochlear damage in the ear, whether it be from damage from chronic loud noise (such as working at a factory for years), ear infections, or fluid in the ear canal.
It has been described in migraine patients though the prevalence is unknown. It is one of the symptoms that can occur as an aura in the International Headache Classification’s criteria for basilar-type migraine, a sub-type of migraine with aura. Approximately 1/4 of basilar-type migraine patients have reported tinnitus as one of the auras (two are required in this criteria for diagnosis).
Tinnitus is difficult to place in the setting of migraine as there are those that do not have aura that report it frequently during their attacks. The current hypothesis is that tinnitus could be perceived similar to what is experienced during cutaneous allodynia during a migraine. Cutaneous allodynia is when there is a sensation of pain where there should not be; many describe a feeling of “hair hurting” or “scalp sensitivity” to touch. Cutaneous allodynia occurs when central sensitization occurs, the point at which a migraine is difficult to control. Perhaps the tinnitus is due to neuronal hyperactivity in the brain stem or even the auditory cortices of the brain. Anecdotally, trigger point injections and occipital nerve blocks have resolved tinnitus during a migraine attack.
Meniere’s disease is a disorder of the inner ear where people have prolonged attacks of vertigo with tinnitus, nausea, vomiting, ear fullness, and progressive hearing loss. It has been described as “the migraine of the inner ear” similar to irritable bowel syndrome being coined as “the migraine of the abdomen”. There is a higher prevalence of migraine patients with Meniere’s disease suggesting a common link. Tinnitus may be related to migraine in this way.
As of now though, it is considered part of the complicated migraine pathophysiology. However, if there is prolonged tinnitus even in the absence of the headache and other symptoms, an audiologic evaluation should be performed in case some neural damage has occurred.