Migraine and Tinnitus Are Closely Connected

Tinnitus and migraines are more than just coexisting conditions—they share a deep neurological link. Our research has uncovered how migraine-driven brain sensitivity can amplify tinnitus, making it louder and more unpredictable. This leads to an unstable, severe form of tinnitus that does not respond to standard treatments.

In this guide, I break down the science behind migraine and tinnitus, why they occur together, and how understanding this leads to better treatment options.

• How are tinnitus and migraines related?
• What is an atypical migraine?
• Can you get migraines secondary to tinnitus?
• What is otologic migraine?
• How are migraine and ear ringing related?
• What triggers tinnitus and migraines?
• What are the best treatment options for tinnitus?

How are tinnitus and migraines related?

Tinnitus and migraines are deeply connected, sharing common triggers and underlying neurological mechanisms. Both conditions can be set off by stress, sleep disturbances, and dietary factors, and they are linked through the same neuroinflammatory pathways that heighten brain sensitivity.

In this article, we examine the neurological overlap between migraine and chronic tinnitus and introduce innovative treatments developed at the University of California, Irvine. This breakthrough approach represents a major step forward, offering new and effective treatment options for tinnitus patients.

Can migraine cause tinnitus?

Yes! The clinical hallmark of migraine is increased sensitivity to sensory information in the brain, so when tinnitus is present, it sounds louder and more intrusive. The greater the activation of migraine, the louder the tinnitus.

Importantly, you don’t have to have a headache to experience migraines. Vestibular migraine and occular migraine are two examples of when people experience migraine without headaches. In these cases, the migraine reaction is not causing headache, it's causing balance or visual symptoms. When it affects the hearing nerve, it causes tinnitus amplification.

Migraine Tinnitus: A Migraine Without Headaches

Again, you can have a migraine without a headache. For some people, tinnitus may be the only manifestation of migraine that they experience.

Migraine is not a singular disorder. Instead, researchers suggest migraine is a sensory processing disorder. With migraine headaches, the sensory symptom that is amplified is head pain. With vestibular migraine, the sensory symptom is vertigo. With ‘migraine tinnitus', the sensory symptom is loud ringing.

What are ‘classic’ migraine headaches?

A classic migraine headache is characterized by severe throbbing head pain. But more than this, migraine sufferers also frequently experience other sensory symptoms during the migraine attack, such as nausea, vomiting, sensitivity to light (photophobia), sensitivity to sound (phonophobia), subjective hearing loss, and loud tinnitus.

Here are some clinical features of a ‘classic’ migraine episode:

Migraine Feature	Description
Headache Pain	Moderate to severe headache pain, lasting hours to days. Headache symptoms are often described as throbbing,
Aura	Sensory disturbances (flashing lights or blind spots) before a headache starts. Not everyone with migraine experiences an aura.
Triggers	Commonly triggered by stress, certain foods, lack of sleep, hormonal changes, and environmental factors.
Symptoms	In addition to headache, a migraine episode can cause nausea, vomiting, sensitivity to light and sound, vertigo, hearing loss, and tinnitus.
Phases	A migraine attack often occurs in phases. The four classic phases are: prodromal, aura, headache, postdrome.

What is a silent migraine?

A silent migraine is a type of migraine that occurs without the characteristic headache of a ‘classic’ migraine. Silent migraine primarily manifests with other migraine symptoms, such as visual disturbances, nausea, sensitivity to light and sound, neck stiffness, ear fullness, sinus or facial pressure, dizziness, vertigo, subjective hearing loss, and ear ringing. 

What is an atypical migraine?

Atypical migraines, also known as “migraine variants”, refer to migraine episodes that deviate from the typical symptoms of a ‘classic’ migraine episode. Common atypical migraine types are listed below:

Migraine Type	Typical Characteristics	Features
Basilar	Aura, dizziness, double vision, and difficulty speaking.	Symptoms originate from the base of the brain or brainstem.
Hemiplegic	Temporary paralysis or weakness on one side of the body (hemiplegia).	Occurs during or after the migraine attack.
Vestibular	Vestibular migraine presents with vertigo, unsteadiness, difficulty with coordination.	May exist with or without headaches.
Otologic	Tinnitus, ear pain (otalgia), ear fullness, hearing changes, vertigo, dizziness.	Encompasses a wide range of conditions.
Retinal	Temporary vision loss, usually lasting less than an hour.	Aura may precede the vision loss. May be on one side only.
Menstrual	Migraine that is closely tied to the menstrual cycle.	Migraine can occur before, during, or after menstruation.
Cervical	Manifests as pain, hypersensitivity, or weakness in the neck.	Can occur before or during a migraine attack.
Abdominal	Spontaneous abdominal pain, nausea, and vomiting.	Typically occurs with intense headaches and in children.

Atypical Migraine in Tinnitus Patients

Many patients with atypical migraine never get migraine headaches. While they may not recognize migraine symptoms, when presented with a list of common atypical migraine signs, they often realize they’ve had them all along but never made the connection.

Migraine tinnitus patients commonly experience symptoms like:

• Neck stiffness or pain.
• Facial or sinus pressure.
• Ear fullness or pressure (aural fullness).
• Chronic facial pain or TMJ symptoms.
• Mental fogginess when the ringing gets very loud. 
• Issues with balance or vertigo (vestibular migraine).

Neck Pain, Migraine, and Tinnitus

Looking specifically at neck pain and tinnitus, we know that subjective ringing and neck pain are significantly correlated [1]. This is called somatic tinnitus, where movement or inflammation in the body affects the loudness of the tinnitus.

At the same time, neck pain is a well-documented symptom of migraine, with research showing that 87% of people with chronic migraine also experience neck stiffness or pain [2]. These overlapping symptoms suggest a common underlying mechanism.

Can you get migraines secondary to tinnitus?

A migraine secondary to tinnitus can happen when the stress response from the tinnitus activates inflammation in the brain. People experiencing severe tinnitus can have heightened stress and anxiety levels. This emotional distress causes inflammation in the brain though hormones like cortisol. This, in turn, may act as a trigger for migraine. 

The opposite is also true. Some people notice that during a migraine attack, tinnitus is more prominent. The interplay between migraine and tinnitus underscores the need for a comprehensive approach to managing both conditions.

Are tinnitus and headache related?

Tinnitus and headache occur together in around 50% of people. Specific headache disorders associated with tinnitus include tension headaches, migraine headaches, and cluster headaches:

• Migraine Headaches: Our research team found that in patients with classic migraine, tinnitus and headache occur together around 35% of the time.
• Tension Headaches: Tension headaches are the most common form of headaches. Research shows that in people with tension headaches, tinnitus and headache occur together 33% of the time.
• Cluster Headaches: Tinnitus severity and decrease in quality of life is worse than in cluster headaches than other headache types. It's characterized by intense, stabbing pain typically localized around one eye or temple, often occurring in clusters or cyclical patterns.

Redefining Migraine: If it's not a headache, what is it?

If you can experience migraine without headaches, what is a migraine? To answer this, we need to look at three important components of migraine; inflammation, sensory hypersensitivity, and central sensitization.

Inflammation in Migraine

Our understanding of migraine has evolved, shifting from a simple headache disorder to a brain inflammation disorder. Research now shows that nerve-driven inflammation plays a central role, with the brain reacting to triggers like stress, poor sleep, and certain foods by releasing inflammatory chemicals.

The key player in this process is calcitonin gene-related peptide (CGRP), a chemical that triggers inflammation in the trigeminal nerve, the main sensory nerve of the head and neck. This discovery has transformed migraine treatment, leading to new therapies that block CGRP to reduce both pain and sensory hypersensitivity.

Sensory Hypersensitivity in Migraine

Inflammation sets the stage for the migraine reaction, but the way that it actually affects us is by causing our sensory nerves to become hypersensitive. All forms of migraine are characterized by an increased sensitivity to various stimuli.

In this sense, researchers have suggested that migraine be considered a sensory processing disorder. Rather than being limited to a specific body part, migraine reflects a lowered threshold for sensory nerve activation, making the brain more susceptible to environmental and physiological stimuli.

Central Sensitization in Migraine

Migraine is also a form of central sensitization, where the brain becomes permanently more sensitive to sensory input. Normally, sensory hypersensitivity occurs in response to inflammation or a trigger, but in central sensitization, the brain rewires itself, keeping the sensitivity threshold constantly lowered.

A key player in this process is CGRP, which not only fuels neuroinflammation but also drives neuroplasticity, reinforcing the brain’s heightened response to stimuli. This increased sensory signaling can lead to long-term changes in brain connectivity, contributing to chronic pain, tinnitus, long COVID, and migraines—all conditions rooted in an overactive nervous system.

Working Definition of Migraine

Given the above, we can say that migraine is a sensory processing disorder driven by neurogenic inflammation, heightened nerve sensitivity, and central sensitization, causing the brain to overreact to environmental and physiological stimuli.

What is otologic migraine?

Otologic migraine (first described by me at UCI) is when the migraine process triggers symptoms in the hearing and balance system. Symptoms of otologic migraine can include the following:

• Tinnitus
• Fluctuating hearing loss
• Sensitivity to loud noises (hyperacusis)
• Ear fullness or pain (aural fullness)
• Vertigo
• Dizziness

Interestingly, we have only recently discovered that these conditions are related to migraine. Here are the various types of otologic migraine:

Condition	Features	Connection to Migraine.
Vestibular migraine	Recurrent bouts of vertigo/dizziness.	Patients may or may not have a migraine history.
Persistent postural-perceptual dizziness (PPPD)	Persistent feeling of unsteadiness, dizziness, or sensation of motion.	53% of patients with PPPD also had migraine [3].
Benign paroxysmal positional vertigo (BPPV)	Recurrent brief episodes of vertigo, triggered by head movements.	50% of patients with BPPV meet the diagnostic criteria for migraine [4].
Mal de Debarquement syndrome (MdDS)	Patients experience feelings of “rocking” as if on a boat, lasting for months to years	73% of MdDs patients treated with a migraine protocol had improved symptoms [5].
Sudden sensorineural hearing loss (SSNHL)	Sudden hearing loss in 3 or more frequencies over a 72-hour period.	SSNHL occurs 1.8x more in patient with migraine than those without [6].
Tinnitus	The perception of ringing, buzzing, hissing, or other similar sounds.	Up to 45% of people with tinnitus also have migraine [7].
Hyperacusis	When sounds are associated with pain, annoyance or fear.	88% of hyperacusis patients treated with a migraine protocol had improved symptoms [8].
Aural Fullness	A persistent sensation that there is fullness or pressure in the ear.	54% of patients meet the diagnostic criteria for migraine [9].
Menière’s disease	Episodic vertigo, fluctuating hearing loss, and tinnitus.	68% of patients meet the diagnostic criteria for migraine [10].

What is vestibular migraine?

Vestibular migraine is a subtype of otologic migraine characterized by vestibular symptoms (vertigo or dizziness), often accompanied by other symptoms such as sensitivity to light and sound, nausea, tinnitus, and headache. Nearly half vestibular migraine patients report experiencing tinnitus during attacks.

Vestibular symptoms like vertigo can be debilitating and significantly impact daily functioning. Vestibular migraine treatment typically involves a combination of lifestyle modifications, medications to prevent migraine attacks, and vestibular migraine rehabilitation therapy to improve balance, reduce symptoms, and restore quality of life.

How are migraine and ear ringing related?

Research suggests that up to 45% of tinnitus patients also experience classic migraine headaches [7]. While the exact percentage of tinnitus cases linked to atypical migraine is still unknown, it is strongly associated with tinnitus severity. Based on my experience, over 80% of individuals with severe tinnitus show signs of atypical migraine.

Here are some of the mechanisms that underlie the connection between migraine and tinnitus:

Mechanism	Description
Trigeminal Nerve Activation	The trigeminal nerve supplies sensation to the face and scalp and is responsible for head pain and migraine pain. It also innervates portions of the ear, providing a direct neurological connection between tinnitus and migraines.
Neurological Hyperactivity	Migraine is linked to abnormal neuronal activity in the brain, and this hyperexcitability may extend to auditory pathways. Tinnitus and migraines share this neurological hyperactivity.
Cortical Spreading Depression	Cortical spreading depression involves a wave of decreased brain activity followed by hyperactivity. This process may influence auditory pathways and contribute to people experiencing tinnitus.
Vascular Changes	Migraine involves alterations in blood flow due to activation of the trigeminovascular system. These vascular changes can affect the inner ear and could potentially contribute to tinnitus.
CGRP Activation	CGRP is the primary molecule that initiates and perpetuates neurogenic inflammation in the migraine reaction. CGRP receptors have been localized to the cochlear artery, inner hair cells, and neurons in the auditory pathway.
Shared Genetic Factors	Genetic predispositions may make individuals more susceptible to both tinnitus and migraines, explaining their co-occurrence in some cases.
Central Sensitization	Chronic tinnitus and migraines may share a common mechanism of central sensitization, where the central nervous system becomes hypersensitive to stimuli, amplifying both pain perception and auditory sensations.

What triggers migraine tinnitus?

A key feature of migraine is that it amplifies sensory hypersensitivity. So when the migraine process is active, it turns the already existing hearing nerve hyperactivity into overdrive, amplifying the tinnitus signal. 

Without the activation of migraine, ear ringing is generally quiet and unobtrusive. Patients with tinnitus without migraine generally don’t notice their ringing during the day and only hear it in silence. However, when the migraine reaction gets triggered, the brain gets very sensitive and amplifies signals in the auditory pathway and auditory cortex, resulting in loud, intrusive tinnitus. 

What are migraine triggers?

A migraine trigger is any factor or stimulus that can initiate the onset of migraine attacks. Identifying and managing triggers is an important aspect of migraine management because it helps people reduce the frequency and severity of migraine attacks. 

Tinnitus shares the same triggers as migraine, but people usually do not think about this because they assume the ringing sound is only related to the ear. The higher the migraine activity the louder the ringing. When the migraine activity in the brain settles down the ringing becomes much quieter. 

 Here are the common triggers that tinnitus and migraines share:

Trigger	Description
Stress	Stress may trigger loud ringing by influencing hormonal release, neurotransmitter imbalances, and the activation of the body's fight-or-flight response. Stress is the most common trigger associated with the onset and maintenance of loud, fluctuating, bothersome tinnitus.
Poor Sleep	Poor sleep can trigger ringing ears by disrupting the balance of neurotransmitters, increasing brain inflammation, and impacting pain perception. Poor sleep can be an interrupted sleep, sleeping too much or too little, insomnia, shifting sleep schedule, or sleep apnea.
Certain Foods	Certain foods can trigger migraine because they are similar to neurotransmitters that trigger tinnitus. That's why a nutrition examination survey is so important in the migraine work up. Also hunger, dehydration, or intermittent fasting can make your ears ring.
Sensory Overstimulation	Sensory overstimulation can trigger tinnitus by overwhelming the nervous system, leading to the release of neurotransmitters and the activation of brain regions associated with pain.
Hormone Levels	Changes in reproductive hormone levels can trigger the migraine process. This is most commonly seen around menopause and with testosterone supplements in men.

In terms of sensory overstimulation for people with tinnitus, this is most commonly seen with loud noise (e.g., louder ringing after going to a loud event – restaurants, concerts, etc.) or atmospheric pressure changes (usually low pressure like thunderstorms, rainy or windy weather, airplane travel, travel to mountains etc.). Reactive tinnitus is a form of tinnitus related to migraine that has sound as its primary trigger.

How does tinnitus start?

Tinnitus usually starts with some kind of hearing loss, although there are a vast number of contributing causes for tinnitus. Many people who develop tinnitus can identify a specific event or time that is tied to when it became problematic. Research shows that the more traumatic the initiating event, the more severe and persistent the ear ringing. 

Common scenarios where patients report first hearing tinnitus:

• Loud noise exposure (shooting guns, concerts, combat)
• Sudden hearing loss
• Viral infections
• Long COVID
• Certain medications (aspirin, IV antibiotics, chemotherapy)
• Any strong inflammatory reaction in the body (e.g., infections, COVID, vaccination, etc)

However, the most common reason why people hear ringing is age-related hearing loss. We all slowly lose hearing as we age. That is why in a very quiet environment or with an ear plug many people can hear a ringing or hissing sound. 

Note that age related hearing loss starts in our early 20s and noise induced hearing loss can occur even as toddlers from a prolonged exposure to loud noises or toys. This is because of a progressive loss of the delicate hair cells in the inner ear. 

Is tinnitus caused by hearing loss?

Ear ringing usually starts with hearing loss, but it doesn't necessarily cause tinnitus loudness. The cause of clinically significant (loud and bothersome) tinnitus has to do with changes in the brain caused by migraine and changes in brain wiring that increase sensory sensitivity (central sensitization).

What causes tinnitus distress?

While up to 50% of people hear ringing when it’s quiet, only around 5-10% of these people experience clinically significant tinnitus. The cause of tinnitus distress is not the signal from the ear, it's the network connections with other areas of the brain. These neural networks are instigated by a migraine reaction in the brain.

To illustrate, consider a person who has hearing loss from aging. If you ask them to pay attention, they will be able to hear some kind of ringing sound. However, if this same person has some major life stressor, the innocuous ringing sound can transform into a loud, persistent, and annoying sensation. In other words, it becomes clinically significant tinnitus.

What changed in this scenario is not the actual ringing sound. Rather, the brain’s sensitivity to auditory information was changed due a stress-induced migraine reaction. The good news is that by controlling the migraine process in the brain, we can make the ringing quiet again.

Is there a connection between pulsatile tinnitus and migraines?

Research findings suggest that there may be a link between pulsatile tinnitus and migraines, as both conditions involve alterations in blood vessels and blood flow within the brain and inner ear. Pulsatile tinnitus is a type of tinnitus characterized by rhythmic or pulsing sounds perceived in the ears or head, often synchronized with the heartbeat. This is called ‘objective tinnitus' because it can often be detected on a physical exam.

People with pulsatile tinnitus and migraines may find that their other symptoms worsen during the attacks. They may note that symptoms are triggered by factors that also provoke migraine, such as stress, certain foods, or hormonal fluctuations.

Effective management of both conditions often involves a multidisciplinary approach, including lifestyle modifications, stress management techniques, medication management for migraine, and, in some cases, specialized treatments targeting vascular abnormalities or underlying contributing factors.

What are the best treatment options for tinnitus?

The best treatment options for tinnitus must incorporate two things; it must address the migraine activity in the brain and change the way the brain is wired so that it doesn’t pay attention to the ringing signal. In medical terms, this means:

• Reducing neurosensory hypersensitivity, and 
• Inducing neuroplastic changes. 

Neuroplasticity is the brain's ability to adapt and change by forming new connections between neurons. So to treat tinnitus, you need to treat the both of the underlying causes – the migraine problem and the brain wiring problem.

Why Ear-Centric Tinnitus Treatments Fail

Many treatment options focus on one of these goals, but the key to tinnitus relief is to address both. Ear-centric tinnitus treatments like sound therapy, tinnitus retraining therapy, or tinnitus hearing aids focus only on using sound to treat tinnitus. They fail to address the neurosensory hypersensitivity that comes with the migraine process.

To accomplish this, you must have a comprehensive rehabilitation program that attacks the ringing problem from multiple angles, called a ‘multimodal’ or ‘integrative medicine’ approach.

Migraine Treatment for Tinnitus Patients

Over the past 7 years, our academic clinic has had tremendous success treating tinnitus with various interventions that are standard for migraine. This includes the avoidance of trigger foods, the use of nutraceuticals, and the addition of migraine medications. These are then added to standard tinnitus treatments, like sound therapy and CBT.

This treatment approach has elements that are consistent with typical migraine protocols as well as mainstream tinnitus treatments. In my clinic, this treatment regimen is having success rates in the 85-90% range.

Can you cure tinnitus?

You cannot cure tinnitus in the sense of making the ringing sound go completely away. However, you can successfully treat clinically significant tinnitus, in that you can relieve tinnitus by lowering the volume, stopping fluctuations, and moving the sound to the background where it doesn’t bother you anymore. 

Conclusion: Migraine Tinnitus is Treatable! 

The connections between tinnitus and migraines are only now becoming clear. Advances in our understanding of otologic migraine in general, and tinnitus in particular, are leading to new treatment options that work. 

Don’t let anyone tell you “nothing can be done about tinnitus”.  Effective treatment options for tinnitus and migraines is now available. An integrative medicine approach can achieve not just long-lasting tinnitus relief, but an overall improvement in health and quality of life. Book a free consultation with our intake staff to see if our program is right for you.

Tinnitus and Migraines References

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