Understanding the Relationship Between Migraine, Hearing Loss, and Tinnitus

An independent association may exist between migraine with subjective hearing loss (HL) and tinnitus, while otologic migraine—defined as the effects of migraine on the ear—may be partly responsible for the association between HL, tinnitus, neck pain and migraine.

Results of the cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) were published in Otology & Neurotology.

Although the pathophysiology of migraine is not fully understood, the condition is commonly associated with tinnitus and HL. According to estimates, these chronic conditions affect approximately 25% and 20% of the adult population, respectively.

To understand the association between the conditions among the US population, researchers evaluated the NHANES national database, which has gathered extensive health and diet-related information from thousands of participants since 1999.

Researchers used data recorded by the database from 1999 to 2004, as this was the only time it included a migraine question. All individuals included (n = 12,962) were between the ages 18 to 65 and the majority (52.9%) were female.

Out of over 12,000 individuals, 2657 (20.5%) reported having migraine, while these participants tended to be women, slightly older, with a high body mass index (BMI), and experience with neck pain. A total of 2344 (18.1%) had subjective HL, and 2582 (19.9%) had tinnitus. “In patients with tinnitus or subjective HL, migraine was reported in 35.6% and 24.5%, respectively,” authors wrote.

Analyses showed:

• Migraineurs were more likely to have subjective-HL (25% vs. 16.6%; P < .001) and tinnitus (34.6% vs. 16.9%; P < .001) compared with non-migraineurs
• Migraine had an odds ratio (OR) of 1.5 (95% CI, 1.3–1.7; P < .001) and 2.2 (95% CI, 2.0–2.4; P < .001) for subjective-HL and tinnitus, respectively
• After adjusting for confounders, subjective-HL (OR = 1.2; 95% CI, 1.1–1.4; P = .003), tinnitus (OR = 2.1; 95% CI, 1.9-2.3; P < .001), and neck pain (OR = 4; 95% CI, 3.6-4.5; P < .001) were more common in migraineurs
• Among migraineurs, a higher proportion of those with tinnitus also had subjective-HL compared with those without tinnitus (40% vs. 15.3%; P < .001), and a higher proportion of those with subjective-HL also had tinnitus compared to those without HL (58.1% vs. 27.3%; P < .001)

Overall, after adjusting for confounders, migraineurs were more likely to have subjective HL and tinnitus than non-migraineurs. Although these findings aren’t new, “many otolaryngologists are unaware of this association due to a paucity of literature on the topic,” researchers wrote.

HL and tinnitus are both present during migraine episodes, while major HL is significantly more common among migraineurs. In addition, “it has been suggested that sudden HL in patients with migraine can be attributed to ischemia from migraine-associated vasospasm,” authors noted.

The hypothesis that idiopathic HL in pre-existing migraine could be related to migraine-induced vasospasm of cochlear vasculature suggests the potential of similar underlying pathophysiologies for migraine and HL or tinnitus.

As the main variables of this analysis were self-reported without objective measures, further details could not be elucidated, marking a limitation to the study. Results should be interpreted with caution as responses are subject to selection bias, recall/reporting bias, inaccurate coding, and other limitations, authors said.

“Despite these limitations, this is the first study utilizing US population-based data to identify significant and independent relationships between migraine, tinnitus, and HL,” they concluded. “This encourages future studies to investigate whether migraine prevention/treatment protocols can prevent or decrease these potentially secondary otologic conditions.”

Reference:

Goshtasbi K, Abouzari M, Risbud A, et al. Tinnitus and subjective hearing loss are more common in migraine: a cross-sectional NHANES analysis. Otol Neurotol. Published online July 7, 2021. doi:10.1097/MAO.0000000000003247