Migraine and Auditory Dysfunction Explained

A substantial 15% to 49% of people with migraine also experience auditory symptoms like tinnitus, hearing loss, or hyperacusis. A 2026 systematic review in the *Journal of Neurology* consolidates the evidence, arguing that these are not just random co-occurrences but direct manifestations of migraine as a disorder of multisensory sensitization.

Migraine as a Systemic Sensory Disorder

Lead authors Wandi Xu, Ni Zhai, and Jingyu Chen, with their team from Huazhong University of Science and Technology, frame migraine as a “systemic disorder of multisensory sensitization.” This perspective moves beyond the traditional view of migraine as primarily a headache disorder. It explains why auditory, visual, and vestibular systems are so frequently involved. The review, published under DOI 10.1007/s00415-026-13957-0 (PMID: 42371148), synthesizes decades of epidemiological, clinical, and pathophysiological data to build this case.

How Migraine Disrupts Hearing: Three Interacting Axes

The researchers propose a model where auditory dysfunction in migraine develops across a peripheral-to-central continuum involving three connected pathways.

Axis 1: Vascular and Hydrodynamic Stress

The inner ear is exquisitely sensitive to changes in blood flow and fluid pressure. The review details anatomical vulnerabilities that can make the cochlea susceptible to the microvascular ischemia and blood flow changes characteristic of a migraine attack. Aberrant fluid exchange between the brain and inner ear may further destabilize the delicate cochlear environment, potentially contributing to symptoms that overlap with conditions like Ménière’s disease.

Axis 2: Local Neurochemical Chaos

Within the inner ear, migraine pathophysiology creates a hostile microenvironment. The paper highlights glutamate excitotoxicity—where excessive glutamate damages sensory cells—and the release of neuropeptides like CGRP (calcitonin gene-related peptide). This local inflammatory and immune activation disrupts the precise homeostasis required for normal hearing, setting the stage for cellular damage and aberrant signaling to the brain.

Axis 3: Central Sensitization and Network Dysfunction

This is where conditions like hyperacusis and tinnitus find their strongest explanation. Migraine drives a state of central sensitization, where the brain’s pain and sensory processing networks become hyper-reactive. The review describes impaired efferent gating, meaning the brain’s ability to filter out irrelevant auditory signals breaks down. Coupled with thalamocortical dysrhythmia—a disruption in the rhythmic communication between key brain regions—this creates the neural signature for persistent tinnitus and sound intolerance.

Clinical Findings and Assessment Gaps

The epidemiological data is compelling, but the review notes that nearly two-thirds of migraine patients show objective abnormalities on auditory electrophysiological tests, such as auditory brainstem responses. This suggests underlying auditory system disruption is even more common than symptom reports indicate. A significant barrier to care is the lack of standardized audiological assessment protocols for this patient group. Symptoms are often overlooked by both neurologists and ENT specialists, leaving patients without a clear explanation for their hearing-related distress.

A New Framework for Treatment Strategies

Moving from mechanism to management, Xu, Zhai, and Chen categorize therapeutic approaches by their clinical objective, offering a structured way to think about intervention.

1. Blocking Upstream Migraine Pathways: This foundational approach uses established migraine preventatives to reduce attack frequency and severity, thereby limiting the systemic insults that trigger the three axes of auditory dysfunction.

2. Protecting the Cochlear Microenvironment: This strategy aims for direct inner ear protection, investigating agents that could mitigate glutamate excitotoxicity, reduce oxidative stress, or calm local inflammation. This aligns with broader research into targeted otic drug delivery.

3. Correcting Central Hypersensitivity: Treatments here target the hyperactive central nervous system. The review notes emerging interest in neuromodulation techniques designed to recalibrate neural networks. While not explicitly covered in this paper, such approaches share a conceptual basis with therapies like tDCS for tinnitus or vagus nerve stimulation, which is being studied for related conditions like misophonia.

Practical Implications for Patients and Clinicians

For patients with migraine who experience ringing in the ears, difficulty with loud sounds, or unexplained hearing fluctuations, this research validates that these symptoms are likely part of their neurological condition. They should proactively discuss them with their healthcare providers. For clinicians, the review is a call to action for cross-disciplinary management. Neurologists should include simple questions about auditory symptoms in migraine evaluations. Audiologists and otolaryngologists should consider migraine in the differential diagnosis for patients presenting with sensorineural symptoms, especially if they are episodic or linked to headache phases.

The ultimate goal, as stated by the authors, is to promote early identification, precise phenotyping, and integrated care. By understanding migraine as a multisystem disorder that commonly involves the ears, more effective and comprehensive treatment plans can be developed.