Migraine and Hearing Disorders Explained

Migraine operates as a systemic disorder of multisensory sensitization, according to a 2026 review in the *Journal of Neurology*. For patients, this means the condition’s impact often extends far beyond head pain, directly affecting the auditory system. The review, authored by Xu, Zhai, Chen and colleagues, consolidates evidence showing that auditory symptoms like hearing loss, tinnitus, and hyperacusis are not just occasional side effects but prevalent otologic features of migraine.

Epidemiology and Clinical Scope of Auditory Symptoms

The review synthesizes epidemiological data indicating a high burden of auditory dysfunction in people with migraine. Between 15% and 49% of migraine patients report comorbid auditory symptoms. These can range from sensorineural hearing loss and persistent tinnitus to debilitating hyperacusis, where everyday sounds are perceived as intolerably loud or painful.

Objective testing reinforces these patient reports. The authors note that nearly two-thirds of migraine patients exhibit auditory electrophysiological abnormalities, even in the absence of a primary hearing complaint. This disconnect between measurable dysfunction and reported symptoms suggests many auditory issues are overlooked in standard migraine care. For more on the broader relationship between hearing disorders and migraine, see our article on Migraine Linked to Hearing Disorders and Tinnitus.

A Three-Axis Pathophysiological Model

The researchers propose a cohesive model explaining how migraine leads to auditory problems. They describe a “peripheral-to-central continuum” across three interacting axes.

Axis 1: Anatomical and Hydrodynamic Vulnerabilities

The first axis involves physical and vascular stress on the auditory system. Anatomical vulnerabilities may drive localized microvascular ischemia, reducing blood flow to critical structures like the cochlea. Aberrant brain-ear fluid exchange is also implicated, potentially disrupting the delicate ionic balance necessary for hearing. This axis shares mechanistic ground with conditions like Ménière’s disease.

Axis 2: Localized Neurochemical Imbalance

Within the inner ear, migraine-related neurochemical changes disrupt homeostasis. The review highlights glutamate excitotoxicity, where excess glutamate damages sensory cells. Signaling by neuropeptides like CGRP (calcitonin gene-related peptide), a key player in migraine, and activation of innate immune pathways further contribute to a toxic microenvironment for auditory function.

Axis 3: Central Sensitization and Network Plasticity

The final axis originates in the brain. Central sensitization, a hallmark of migraine, facilitates maladaptive neural plasticity in auditory networks. This manifests as impaired efferent gating—the brain’s ability to filter out irrelevant sounds—and thalamocortical dysrhythmia, where abnormal brain wave patterns contribute to the perception of tinnitus. This central hypersensitivity is a likely driver of hyperacusis and some forms of tinnitus, linking to conditions like misophonia and sound sensitivity.

Implications for Clinical Management and Treatment

This three-axis framework directly informs therapeutic strategy. The authors categorize approaches by their clinical objective.

1. Blocking Upstream Migraine Pathways: Preventive medications that reduce migraine frequency, such as CGRP monoclonal antibodies, may indirectly protect the auditory system by stabilizing the shared neurochemical and vascular environment.

2. Protecting the Cochlear Microenvironment: Treatments aimed at reducing oxidative stress, inflammation, or excitotoxicity within the inner ear could be explored, potentially borrowing from otologic therapies for other conditions.

3. Correcting Central Hypersensitivity: This is where neuromodulation and sound-based therapies come into focus. Techniques like tinnitus retraining therapy or prolonged sound therapy aim to recalibrate the hyperactive central auditory pathways. Cognitive behavioral therapy can also help manage the distress associated with chronic tinnitus and hyperacusis.

Moving Toward Cross-Disciplinary Care

A primary conclusion of the review is that optimal management requires moving beyond isolated specialties. The authors call for early identification, precise clinical phenotyping of migraine patients’ auditory symptoms, and cross-disciplinary management. An integrated team involving neurologists, otolaryngologists, and audiologists is best positioned to address the complex interplay between migraine and auditory dysfunction.

The evidence compiled by Xu, Zhai, Chen et al. reframes migraine as a multisystem disorder with significant auditory consequences. Recognizing this link is the first step toward more comprehensive assessment and targeted treatment for the many patients whose migraine burden includes the often-debilitating dimension of auditory dysfunction.

Source: Xu W, Zhai N, Chen J, et al. Migraine and auditory dysfunction: beyond comorbidity. J Neurol. 2026;273(7):433. PMID: 42371148.