By: Mia Minen, MD, MPH

Key Points

  • Tinnitus can be seen in multiple headache disorders.
  • Tinnitus patients and headache patients share similar complaints.
  • There are treatment options available for tinnitus.

Introduction

Chronic tinnitus, or the perception of hearing sounds without an external noise stimulus, afflicts about 10-15% of the population. The sounds may be described as ringing, roaring, hissing, or pulsatile, to name a few adjectives.

Examples of Headache Disorders with Tinnitus

Tinnitus can be associated with multiple types of headache disorders. One headache type where tinnitus is sometimes seen is migraine. Some patients report that their tinnitus worsens only and consistently during migraine attacks. In migraine patients with cutaneous allodynia, the allodynia may occur in parallel with the development of the tinnitus.

Tinnitus may also rarely be seen in migrainous infarction, when a patient has a migraine at the same time his or her Magnetic Resonance Imaging (MRI) reveals a corresponding stroke. Another type of headache type where tinnitus may be seen is idiopathic intracranial hypertension (IIH). In fact, some people think that because the symptoms of IIH may be indistinguishable from the symptoms of migraine headaches, the presence of pulsatile tinnitus, frequently observed in IIH may help with diagnosis. A third example is post concussive headache, which may be part of a post-concussive syndrome, of which tinnitus may also be a symptom.

Explanations for the Causes of the Co-occurrence of Headache and Tinnitus

Multiple hypotheses have been formed to explain why tinnitus and headache may co-occur. Some researchers suggest that it could be from spontaneous abnormal neural activity. Others suggest it may be an allodynic symptom. More investigation needs to be done in this area.

Other symptoms may co-occur with headache and tinnitus

Both tinnitus patients and headache patients share common complaints. These complaints include but are not limited to depression, anxiety, sleep disturbances, and increased stress levels. Cognition can also be affected.

Treatments for Tinnitus

There are both non-pharmacologic and pharmacologic treatments available for tinnitus. Certain patients may benefit from particular lifestyle modifications, such as following a low salt diet, and abstaining from alcohol or caffeine. White noise machines or fans may also be effective in lessening the impact of tinnitus on one’s quality of life. Habituation Retraining Therapy (HRT) or Cognitive Behavioral Therapy (CBT) may also be effective forms of non-pharmacologic treatment. In addition, certain medications such as long acting benzodiazepines may also decrease the intensity of the tinnitus.

Discuss the treatment options with your doctor to find out which ones might be right for you.

Mia Minen, MD MPH, Departments of Neurology and Psychiatry, Massachusetts General Hospital, Boston, MA

This article is a legacy contribution from the American Headache Society Committee for Headache Education (ACHE) and the Fred Sheftell, MD Education Center.