Are ADHD and Tinnitus Related?

In this review, we'll cover some fascinating links between attention deficit hyperactivity disorder (ADHD), tinnitus, and migraine. Here are some of the topics we'll cover:

• What is ADHD?
• What is the relationship between tinnitus and ADHD in the brain?
• How are ADHD and tinnitus clinically similar?
• Is ADHD related to hyperacusis and misophonia?
• How are ADHD and migraine connected?
• How do you treat ADHD and tinnitus?

What is ADHD?

ADHD is a mental health condition characterized by persistent patterns of inattention, hyperactivity, and impulsivity that significantly impact daily functioning and development. ADHD is typically diagnosed in childhood but can persist into adolescence and adulthood.

The American Psychiatric Association has categorized ADHD into three distinct presentations:

• Predominantly inattentive presentation.
• Predominantly hyperactive-impulsive presentation.
• Combined presentation.

Inattentive-Type ADHD in Adults

The inattentive type is the most common, especially in adults. This is because ADHD hyperactivity is higher in children, but much lower in adolescents and adults. According to the formal diagnostic criteria (DSM-5), adult ADHD must have at least 5 inattentive symptoms for at least 6 months [1].

It's interesting that inattentive ADHD symptoms are nearly identical to typical brain fog symptoms:

ADHD Diagnostic Criteria	Similarity with Brain Fog Symptoms
“Often fails to give close attention to details or makes careless mistakes… at work, or during other activities.”	This aligns with the forgetfulness, absent-mindedness, and difficulty concentrating in a person with brain fog.
“Often has difficulty sustaining attention in tasks or activities.”	This reflects the trouble focusing and inability to concentrate seen in brain fog.
“Often does not seem to listen when spoken to directly.”	This can be related to the mental fog or feeling of being disconnected that a person with brain fog may experience.
“Often has difficulty organizing tasks and activities.”	Brain fog can impair cognitive functioning, making it difficult to plan, organize, and execute tasks effectively.
“Is often easily distracted by extraneous stimuli.”	Brain fog can contribute to heightened distractibility and difficulties in filtering out irrelevant information.
“Is often forgetful in daily activities.”	Forgetfulness is a common symptom of brain fog, affecting various aspects of daily life.

Many people who suffer from chronic tinnitus experience these symptoms. “Tinnitus brain fog” has been likened to mild cognitive impairment in some studies, but it may actually be better characterized as symptoms consistent with inattentive ADHD [2].

Importantly, the combination of tinnitus and brain fog is also very common in long COVID. It would be interesting to know how many people with tinnitus and long COVID would fit the diagnostic criteria for inattentive ADHD.

ADHD and Sensory Processing Issues

New research shows that inattention symptoms in ADHD are due to sensory processing issues. To understand this, you need to first understand two important concepts in sensory processing; attention and habituation.

• Attention refers to the cognitive process by which the brain selects and focuses on specific stimuli or information while ignoring irrelevant or distracting input. This process involves complex interactions between various brain regions.

• Habituation is a decrease in response to a repeated or continuous stimulus over time, occurring at the level of neuronal processing. It is a fundamental adaptive mechanism that allows organisms to filter out irrelevant or non-threatening stimuli from their environment, conserving cognitive resources for processing novel or important information.

The relationship between habituation and attention lies in their roles in information processing: attention involves selectively allocating cognitive resources to specific stimuli while habituation reduces the responsiveness of neurons to repeated stimuli.

In sensory processing disorders like ADHD, attention and habituation are altered, contributing to trouble filtering and processing sensory stimuli. Interestingly, these exact functional domains are impaired in chronic tinnitus.

What is the relationship between ADHD and tinnitus in the brain?

There are multiple cross-over points in neurobiology between tinnitus and ADHD, including their involvement with the attention center and the corticolimbic system. Here is a list of the neurobiological similarities between ADHD and tinnitus:

Neurological Feature	Description
Sensory Over-Reactivity	Both conditions exhibit heightened sensitivity or over-reactivity to sensory stimuli, especially to sounds.
Deficits in Habituation	Both conditions feature impairments in habituation, leading to prolonged or exaggerated responses to stimuli.
Altered Attentional Mechanisms	Both conditions are associated with alterations in attentional processes, including difficulties in sustaining attention and inhibiting irrelevant stimuli.
Dysregulation of Neurotransmitter Systems	Both conditions are linked to dysfunctions in neurotransmitter systems such as dopamine, serotonin, and norepinephrine, which regulate sensory processing, attention, and arousal.
Involvement of Limbic and Cortical Structures	Both conditions involve alterations in limbic and cortical structures implicated in emotional regulation, sensory integration, and cognitive control.
Dysregulation of Neural Networks	Both conditions have alterations in the functioning of neural networks implicated in sensory processing, attention, and arousal.
Abnormalities in Cortical Excitability	Both conditions exhibit abnormal patterns of cortical excitability, contributing to hypersensitivity in sensory processing regions of the brain.

How are ADHD and tinnitus clinically similar?

The relationship between ADHD and tinnitus can be appreciated by looking at their highly similar clinical presentations.

Clinical Feature	Description
Attentional difficulties	Attention and concentration problems are seen in both tinnitus and ADHD (and migraine). One study of tinnitus patients found that tinnitus severity scores correlate with ADHD inattention scores [2].
Anxiety	Anxiety sensitivity (AS) is elevated in both tinnitus and ADHD (just like migraine). Anxiety sensitivity describes a fear of physiological sensations, leading people to misinterpret bodily changes as dangerous.
Fluctuating symptoms	Symptoms of both tinnitus and ADHD can fluctuate over time, with periods of exacerbation and remission (just like migraine).
Environmental trigger sensitivity	People with tinnitus and ADHD have heightened sensitivity to environmental triggers (just like migraine). Loud noises or stressful situations can exacerbate both tinnitus and ADHD symptoms.
Comorbid migraine	Both ADHD and tinnitus co-occur with migraine (no surprise). Migraine itself is a sensory processing disorder, so tinnitus and ADHD can be viewed as different manifestations of the same migraine process.

Is ADHD related to hyperacusis and misophonia?

Recent clinical data shows that there is a strong link between ADHD and both hyperacusis and misophonia. This connection is also seen in other ADHD-related neurodevelopmental disorders, like autism. Hyperacusis and misophonia also exist on a spectrum with tinnitus, as all three conditions are auditory processing disorders.

What is hyperacusis?

Hyperacusis is a condition characterized by an increased sensitivity to everyday sounds, leading to discomfort or pain in the ears when people hear normal levels of noise.

What is misophonia?

Misophonia is an auditory processing disorder where certain sounds trigger strong negative emotional reactions, such as anger, anxiety, or disgust.

How are hyperacusis and misophonia related?

The key difference between hyperacusis and misophonia lies in the nature of the sensitivity: hyperacusis involves an overall heightened sensitivity to all sounds, while misophonia involves a selective sensitivity when people hear particular trigger sounds.

How are ADHD and migraine connected?

People with ADHD are nearly 2 times more likely to develop migraine headaches. Likewise, the prevalence of ADHD in people with migraine is significantly elevated. Further, migraine patients without an ADHD diagnosis score nearly twice as high on inattention measures than non-migraine patients [3].

In addition, many of the features noted above are shared in ADHD, migraine, and tinnitus, including:

• Symptom flare ups
• Trigger sensitivity
• Anxiety sensitivity

In fact, if you compare a list of common ADHD, migraine, and tinnitus triggers, they are all nearly identical The most common triggers for all three conditions include:

Trigger	Description
Sensory over-stimulation	Sensory overload, such as loud noises, bright lights, or strong odors.
Stress	Stressful situations, including both emotional distress and physiological stress.
Sleep disturbances	Lack of sleep, insomnia, sleep apnea, or irregular sleep patterns.
Hormonal changes	Fluctuations in hormone levels (menstruation, menopause, testosterone replacement).
Weather changes	Changes in weather patterns, particularly shifts in barometric pressure or temperature.
Dietary factors	Common dietary triggers, including caffeine, alcohol, processed foods, artificial additives, fermented products, etc.
Dehydration	Inadequate hydration can exacerbate symptoms of all three conditions.

How do you treat ADHD and tinnitus?

For adults with tinnitus and inattentive ADHD, a number of treatment options may be helpful. It should not surprise you that some of these recommendations overlap with the migraine prophylaxis protocols we use at NeuroMed. I'll leave out stimulant medications, as I address that below:

Intervention	Description
Non-stimulant medications	Very low doses of tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) can be helpful if you have stress, insomnia, depression symptoms, or anxiety disorder.
Behavioral therapy	Cognitive behavioral therapy (CBT) teaches coping skills and organizational strategies to manage symptoms.
Lifestyle modifications	Structured routines, exercise, sleep, and diet changes can help manage symptoms.
Mindfulness and relaxation techniques	Practices like deep breathing and yoga reduce emotional dysregulation and improve mental health issues in general.
Environmental modifications	Minimizing sensory overstimulation is important, especially when it concerns sound. For instance, avoid loud music for those with noise sensitivity.
Sound Therapy	There is emerging evidence that by providing auditory sensory input from some external source, you can help correct some of the common ADHD symptoms.
Complementary and alternative therapies	This includes nutraceutical therapies, which I will discuss below.

Does Adderall cause tinnitus?

Drugs like Ritalin and Adderall are stimulants that are considered front-line therapy for ADHD. They work by boosting brain chemicals to improve attention and impulse control.

While there have been anecdotal reports linking these drugs to tinnitus, there is limited evidence to support a direct causal relationship. Tinnitus can occur as a side effect of various medications, but it is not a commonly reported side effect of Adderall in clinical studies or prescribing information.

Does sound therapy work for ADHD?

Some studies suggest that certain types of sound therapy may have a modulating effect on neural activity and attentional processes, potentially benefiting individuals with ADHD.

One proposed mechanism behind sound therapy's effectiveness in ADHD is its ability to modulate cortical arousal levels and sensory gating mechanisms. Furthermore, sound therapy interventions may also target emotional regulation and stress reduction, which are areas of difficulty for individuals with ADHD.

What is the best background noise for ADHD?

Certain types of sound therapy, such as music therapy or binaural beats, have been suggested to promote relaxation, improve mood, and reduce anxiety, potentially contributing to better attentional functioning in individuals with ADHD.

Does ADHD brown noise therapy work?

Brown noise is a type of noise used in sound therapy and it may help with ADHD. It has a random pattern generated through mathematical algorithms that results in a fuller and richer sound compared to white noise. This makes it a popular choice for sound masking, relaxation, and sleep aid applications.

Random noise stimulation has been tested both as an acoustic file and as a transcranial random noise stimulation (tRNS) in patients with ADHD. Several studies show preliminary promising results in a number of measures of ADHD severity, although more research is needed.

What are the best supplements for ADHD tinnitus?

Not surprisingly, the best supplements for ADHD are also the best for both tinnitus and migraine. If you have tinnitus with inattentive type ADHD symptoms, these supplements may be helpful. Note that these are among the core dietary supplements we use in our tinnitus protocols. Here are three options that have good preliminary clinical data to support their use.

Does vitamin D help ADHD?

Emerging research has revealed a possible link between vitamin D deficiency and ADHD, a finding that echoes similar associations observed in conditions such as tinnitus. Notably, there is strong scientific evidence supporting the potential therapeutic utility of vitamin D supplementation in both tinnitus and migraine management.

Does melatonin help ADHD?

Melatonin is extensively studied as an adjunctive therapy for individuals with both ADHD and sleep disorders, which affects most people with this condition (up to 70% of the time). Given that sleep disturbances are a common trigger for ADHD symptoms, melatonin's potential to regulate sleep patterns is promising. Additionally, melatonin is being investigated as a supplement for managing both tinnitus and migraine, highlighting its multifaceted therapeutic potential.

Does CoQ10 help ADHD?

Coenzyme Q10 (CoQ10) has been studied extensively as an adjunctive therapy for migraine, with promising data coming from clinical trials. Furthermore, CoQ10 supplementation has been explored as a treatment option for tinnitus given that low CoQ10 is associated with atypical migraine development, which in turn increases tinnitus loudness. Recently, a randomized controlled clinical trial has demonstrated the beneficial effects of CoQ10 in managing symptoms of ADHD [5], shedding light on its potential as a complementary treatment approach for this neurodevelopmental disorder.

Does magnesium help ADHD?

Magnesium supplementation serves as an adjunctive therapy for migraine and tinnitus, with emerging research exploring its potential for ADHD management. A study investigating the co-administration of vitamin D and magnesium for ADHD reported statistically significant improvements in multiple clinical indicators of ADHD severity [6], highlighting the therapeutic promise of this combination approach.

Conclusion: The ADHD Tinnitus Connection is Real

There is a wealth of findings to support an ADHD-Tinnitus connection and many of them are consistent with the research we are doing between tinnitus and migraine.

ADHD and tinnitus appear to be along a spectrum of sensory processing disorders that have the migraine reaction in the brain as a common denominator. There are multiple touchpoints that the two conditions have in common, including shared pathophysiology, overlaps in clinical symptoms, shared triggers, and similar treatments. It's safe to say that we'll be exploring this connection further in clinical trials.

Remember, you don’t have to have a headache to have migraine. Our extensive research into atypical forms of migraine has found that in some people, the only manifestation of migraine is that your tinnitus becomes loud. Fortunately, this problem is treatable with a comprehensive approach that NeuroMed Tinnitus Clinic is implementing for patients across the globe.

ADHD and Tinnitus References

1. de la Peña IC, Pan MC, Thai CG, Alisso T. Attention-Deficit/Hyperactivity Disorder Predominantly Inattentive Subtype/Presentation: Research Progress and Translational Studies. Brain Sci. 2020 May 14;10(5):292.
2. Kumbul YC, Işik Ü, Kiliç F, Sivrice ME, Akin V. Evaluation of Anxiety Sensitivity, Anxiety, Depression, and Attention Deficit Hyperactivity Disorder in Patients with Tinnitus. Noise Health. 2022 Jan-Mar;24(112):13-19.
3. Gonzalez-Hernandez A, Cano-Yepes A, Sainz de Aja-Curbelo V, Santana-Farré R, Rodríguez-Sosa T, Cabrera-Naranjo F. Attention Deficit Hyperactivity Disorder in Adults With Migraine. J Atten Disord. 2024 Jan;28(1):117-122.
4. Massoodi A, Javadian Koutanaei S, Faraz Z, Geraili Z, Zavarmousavi SM. Comparison of serum vitamin D levels between healthy and ADHD children. Caspian J Intern Med. 2023 Fall;14(4):681-686.
5. Gamal F, El Agami O, Salamah A. Coenzyme Q10 in the Treatment of Attention Deficit Hyperactivity Disorder in Children: A Randomized Controlled Trial. CNS Neurol Disord Drug Targets. 2022;21(8):717-723.
6. Hemamy M, Pahlavani N, Amanollahi A, Islam SMS, McVicar J, Askari G, Malekahmadi M. The effect of vitamin D and magnesium supplementation on the mental health status of attention-deficit hyperactive children: a randomized controlled trial. BMC Pediatr. 2021 Apr 17;21(1):178.