“Tinnitus is a condition that affects approximately 10% of the adult population in the United States and can diminish one’s quality of life,” explains Hamid R. Djalilian, MD. “To date, there are no definitive or FDA-approved treatments for tinnitus, and many patients must resort to sound therapy or cognitive behavioral therapy. My colleagues and I hypothesized that there is an underlying pathophysiologic connection between migraine and ear issues, which we call otologic migraine. We discovered that migraine medications can improve certain types of hearing loss (HL) and tinnitus in a selected population. This is also true for sudden sensorineural HL, with which a recent study of ours showed that many patients who are refractory or late to traditional steroid management can benefit from migraine medication. However, the understanding between migraine and ear disease is poorly understood by the medical community.”

To test their hypothesis, Dr. Djalilian and colleagues sought to investigate whether migraine is independently associated with tinnitus and subjective HL by utilizing the National Health and Nutrition Examination Survey (NHANES) database. For a paper published in Otology & Neurology, the researchers retrospectively queried the de-identified 1999 and 2004 NHANES database for patients aged 18-65, among whom HL and tinnitus were subjectively reported.

Migraine a Major Risk Factor for Tinnitus & Hearing Loss

The study team included 12,962 patients in the analysis, of which 21% had migraine, 18% had subjective HL, and 20% had tinnitus. After adjusting for the effects of several variables (eg, age, gender, race, BMI, and neck pain), they determined that the presence of migraine was a significant risk factor for tinnitus and subjective HL.

Multivariate logistic regression demonstrated that older age, higher BMI, female gender, neck pain, subjective HL, and tinnitus were all independently associated with migraine. “We found that after adjusting for important confounders, patients with tinnitus were 2.1 times more likely to have migraine compared with patients without tinnitus, and patients with subjective HL were 1.2 times more likely to have migraine compared with patients without HL,” Dr. Djalilian says. “This supports our hypothesis that migraine is independently associated with an increased likelihood of subjective HL and tinnitus, while patients with subjective HL or tinnitus were also more likely to have migraine (Table).”

Patients with migraine were more likely to have subjective HL and tinnitus than those without migraine, even after adjusting for confounders. “Although these relationships are significant and may influence how patients suffering from these conditions receive medical treatment, many neurologists and pain specialists are unaware of this association, due to a paucity of literature on the topic,” Dr. Djalilian notes.

Physicians Should Inquire About Secondary Symptoms

Neurologists, primary care physicians, and pain specialists see a significant number of patients with migraine in their practices, explains Dr. Djalilian, adding that he hopes these findings encourage physicians to inquire about secondary otologic symptoms, such as tinnitus and HL, and counsel patients that migraine prevention and treatment protocols can potentially alleviate these secondary symptoms. “There are also a significant number of people with tinnitus or low frequency or flat HL without a migraine diagnosis,” Dr. Djalilian says. “Our research suggests that the tinnitus or low frequency or flat HL in many of these patients is still due to migraine brain processes and thus can benefit from migraine prevention/treatment protocols.”

Dr. Djalilian and colleagues note the need for future large-scale randomized controlled trials to test the utility of migraine prevention and treatment protocols for migraine-related tinnitus or HL. “We also need to investigate the exact pathophysiologic links between migraine with HL and tinnitus. Our study utilized a de-identified national database with a limited number of variables; thus, future institutional studies with more controlled and objective measures are warranted to further evaluate the cross-sectional relationship between migraine with HL and tinnitus. We also need more funding in this area, since there is very little funding for migraine and tinnitus at the federal level.”