Sometimes two common conditions- tinnitus and headache- co-occur in some people. But are these conditions truly related or are they simply co-occurring because they are both common conditions?
According to the World Health Organization (WHO), the prevalence of headache disorders in adults is nearly 50% worldwide, meaning that 50% of adults experience at least one headache annually. Similarly, tinnitus prevalence ranges from approximately 10 to 30% of adults, with the prevalence of chronic tinnitus to be estimated at approximately 10%. Is the overlap by chance or due to a unifying diagnosis?
Oto presents pertinent information about tinnitus and headaches, when the two conditions could possibly be related, and how the Oto app can help.
The Link Between Tinnitus and Migraines
Tinnitus and migraines share many commonalities: both conditions are localised to the head, symptoms can vary from person to person and both conditions are invisible and can be hard to diagnose and treat. It's important to consult your general practitioner to determine if there might be a unifying diagnosis that would explain the tinnitus and headache co-occurring such as:
- Headache disorder
- Temporomandibular joint (TMJ) dysfunction
- Traumatic brain injury (TBI)
- Carotid artery dissection
For people with headaches or migraines and tinnitus, other conditions may co-occur such as anxiety, depression, and sleep disturbance. The important thing to bear in mind is that the better each condition is addressed, the better the overall quality of life will be.
If you are living with tinnitus, you know that tinnitus can vary in intensity, duration, and sound quality. The tinnitus may be transient and pass after minutes to days, or it may be longer-lasting and persist for weeks to months or longer.
The good news is that with time and treatment, tinnitus should become less noticeable and intrusive. Significant signs that tinnitus is going away would include periods where you do not notice the tinnitus, sensing that the tinnitus is softer or less obtrusive, and being able to ignore it and resume normal life activities.
Can Tinnitus Cause Headaches?
The easy answer is that tinnitus is caused by a change in the auditory system, essentially change in hearing or hearing loss, and as such would not be believed to cause headaches. Tinnitus may be accompanied by other conditions such as hearing loss, aural fullness (ear fullness), or otalgia (ear pain).
It's possible that an underlying condition such as migraine could be a unifying diagnosis for tinnitus and headaches. Experiencing bothersome tinnitus may be the stage for a headache to occur (e.g. increase in stress), but technically tinnitus isn't the exact cause of headaches.
Pulsatile Tinnitus And Headaches
First, it can be helpful to understand what is pulsatile tinnitus - head noise with a "beating" sensation or sound quality. The pulsing may go along with your heartbeat, and depending on the cause, the pulsatile tinnitus may be inaudible to others (subjective tinnitus) or audible to others such as a medical doctor (objective).
The important thing to know about pulsatile tinnitus, with or without headaches, is that you should seek medical evaluation for this condition as it could be a sign of a medical problem. One condition that may cause pulsatile tinnitus and headaches is benign intracranial hypertension.
Put simply, benign intracranial hypertension, sometimes also referred to as idiopathic intracranial hypertension (IIH), is high pressure in the fluid that surrounds the brain in the skull. It occurs most commonly in women ages 25-40 (but can occur in anyone at any age), in people who are overweight or obese, and in people with chronic kidney failure and certain thyroid disorders.
In addition to pulsatile tinnitus, benign intracranial hypertension / IIH can cause other symptoms such as headache, dizziness, nausea, vomiting, neck stiffness, changes in vision including loss of peripheral vision, trouble walking, depression, and forgetfulness. Some of these symptoms can be worrisome and are similar to symptoms of a brain tumour, so it's important to seek medical evaluation if you notice them.
Headaches Versus Migraines
Symptoms Of Headaches
- Mild to severe head pain
- Localised to forehead, both sides of the head, the temple, or the back of the head
- Lasting 30 minutes to one week
Symptoms Of Migraines
The English word, "migraine" comes from the Greek words meaning "half" and "skull," attributing to the one-sided nature of head pain that is a defining characteristic of migraine that distinguishes it from a headache. Migraine affects nearly 12% of the population.
Migraine is typically characterised by having symptoms of a headache plus any of the following:
- Pain localised to temples or behind one ear or eye
- Pain is typically one-sided but can affect both sides
- Moderate to severe throbbing pain that interferes with daily activities
- Pain may be severe and cause the sufferer to go to the Emergency Room
- Nausea and/or vomiting
- Vision changes including blurriness, temporary / transient loss of vision, seeing spots or lights
- Photosensitivity (sensitivity to light) or sensitivity to sound
Migraines are further sub-categorized as occurring with or without aura. "Aura" refers to seeing lights or lines, feelings of mental fogginess, and other sensations such as tingling, numbness, smell, taste, or touch approximately 10-30 minutes before the migraine begins.
Central Sensitization In Migraines And Tinnitus
There seems to be a connection between people who suffer from migraines and people who have tinnitus, and the common thread is how the brain neurologically interprets input. In fact, there may be a biochemical reason for this: The trigeminal nerve releases inflammatory peptides which could cause the throbbing pain associated with migraine.
After several migraines, central sensitisation may occur and pave the way for tinnitus to start. Conversely, unilateral tinnitus may sensitise the trigeminal nerve system and trigger migraines on the same side.
Research supports that migraines precede tinnitus (perhaps because they are more prevalent in younger people whereas tinnitus is associated with a change in auditory status which is more common in older adults), but favours a biological connection nonetheless.
People That Suffer From Migraines Are More Likely To Develop Tinnitus
Tinnitus is a commonly reported side effect of migraines, but people who suffer from migraines are also more likely to report having tinnitus. An ode to the age-old question of the chicken and the egg: some may wonder whether having headaches could cause tinnitus or vice versa.
Often, tinnitus can be reported when a migraine occurs but some may wonder whether is there an association between tinnitus and other cochlear disorders with a history of migraines? No matter the chain of effects, it's good to know that:
- Roughly 20% of people who have migraine report tinnitus as a symptom
- 26-47% of people who have tinnitus also report having headaches
Tinnitus And Constant Headache
A headache is considered to be chronic if it occurs more than 15 days per month and lasts for at least three months. When tinnitus also occurs, it could be a sign of a migraine.
Persistent headaches accompanied by tinnitus can seriously disrupt daily living and have a significant impact on quality of life. Most people find relief knowing that there are ways to treat headaches, migraines, and tinnitus.
How To Treat A Migraine?
Prevention may be the best medicine: identifying triggers can help you to avoid migraines in the first place. There are also lifestyle modifications that can be made to lessen the occurrence of migraines.
- Identify and prevent triggers such as caffeine and alcohol intake, specific foods and additives (MSG), or environmental triggers such as bright light and odors
- Manage stress and anxiety
- Weather changes
- Practice good sleep hygiene
- Be aware of medications that can trigger or exacerbate migraines (oral contraceptives and vasodilators) and discuss the merits and risks of these medications in light of managing migraines
- Be aware that hormonal changes, such as during the menstrual cycle or during menopause, can affect migraines
If lifestyle modification and gentle therapies aren't helpful, some medications may help to prevent or lessen migraines. It's important to also rule out other medical causes for headaches and migraines so it may be time to consult your general practitioner to see if a referral to a neurologist is warranted.
Laterality And Severity Seem To Correlate
For people with tinnitus and also migraine, there are some correlations between symptoms. One study that looked at these correlations found the following results:
- 27% of participants with tinnitus self-reported that they also suffer from headaches, which is not significantly different from the prevalence of headache in the general population
- Women more often suffer from a unilateral headache than men
- Participants with all forms of headache more commonly reported TMJ complaints and vertigo
- Participants with tinnitus and migraine scored higher (more severely) on some quality of life and depression inventory rating scales than people with tinnitus who do not suffer from headaches
- Headache type did not affect sensitivity to loud sound, but participants with migraines were more likely to report pain in response to loud sound
- There was no effect on mask-ability of tinnitus for participants with migraine
"The main findings of this study are that tinnitus patients with comorbid headache have higher scores in TQs, lower quality of life, and more frequently comorbidities such as painful sensation to loud sounds, vertigo, neck pain, TMJ complaints, general pain, and depressive symptoms when compared with tinnitus patients without headaches. The higher impairment in quality of life in patients who suffer from both tinnitus and headache can be easily explained by a purely additive effect of both disorders on disease burden."
Tinnitus and headache can be bothersome and intrusive but Oto is here to help. The Oto app offers the following treatment options to manage tinnitus and headaches:
- Cognitive Behavioral Therapy (CBT) is a safe and effective way to treat tinnitus. It can change the way you process and feel about health conditions and can be a powerful tool for reframing negative thoughts and emotions.
- Guided imagery helps to redirect attention and focus.
- Relaxation activities promote a feeling of wellbeing.
- Masking noise can calm tinnitus.
- Oto now offers a tinnitus support group.