Migraines and Hearing Disorders: Key Connections

A 2026 review in the *Journal of Neurology* presents a compelling case: migraine should be understood as a systemic disorder that frequently disrupts hearing. The authors report that between 15% and 49% of people with migraine experience comorbid auditory symptoms like tinnitus and hyperacusis, and nearly two-thirds show measurable abnormalities in auditory processing.

## The Migraine-Auditory Link: More Than Coincidence

For decades, the connection between migraine and hearing issues was often dismissed as simple comorbidity—two separate conditions happening to occur in the same person. The review by Xu, Zhai, Chen, and colleagues argues this view is outdated and incomplete. They synthesize evidence to show that auditory dysfunction is a direct, mechanistic phenotype of migraine itself. The high prevalence rates are not accidental; they are a consequence of the underlying biology of migraine as a “systemic disorder of multisensory sensitization.” This reframes conditions like migraine-associated tinnitus or hyperacusis not as separate problems, but as expressions of the same neurological event. For patients, this can validate often-overlooked symptoms and point toward more targeted treatment avenues, as explored in our previous article on Migraine Linked to Hearing Disorders and Tinnitus.

## Three Pathological Axes Connecting Brain and Ear

The researchers propose that migraine disrupts hearing through a “peripheral-to-central continuum” across three interconnected axes. This model explains why symptoms can range from fleeting tinnitus during an attack to permanent sensorineural hearing loss.

The first axis involves anatomy and fluid dynamics. Migraine-related vascular changes can cause localized microvascular ischemia in the delicate inner ear. Furthermore, aberrant brain-ear fluid exchange may disrupt the precise ionic balance the cochlea needs to function, a vulnerability that shares some features with other fluid-regulation disorders like Ménière’s disease.

The second axis is local neurochemical imbalance within the inner ear. The review details how migraine mechanisms—glutamate excitotoxicity, neuropeptide signaling (like CGRP), and innate immune activation—can spill over into the cochlear microenvironment. This creates a state of inflammation and neuronal hyperexcitability at the very periphery of the hearing system.

The third and central axis is neural network plasticity in the brain. Migraine is a driver of central sensitization, a condition where the nervous system becomes hyper-reactive. This manifests in the auditory system as impaired efferent gating (the brain’s ability to filter out irrelevant sound) and thalamocortical dysrhythmia, where abnormal brainwave rhythms generate phantom perceptions like tinnitus. This central hypersensitivity is a shared pathway with other conditions, such as the link described between PTSD and Tinnitus.

## Clinical Implications: From Mechanism to Management

A significant clinical hurdle has been the variable approach to audiological assessment in migraine patients. The paper notes that standard pure-tone audiometry may be normal, while more sensitive tests like otoacoustic emissions (OAEs) or auditory brainstem responses (ABRs) reveal dysfunction. This suggests routine hearing checks in migraine clinics may need to be more comprehensive to catch subtle issues early.

The proposed three-axis model directly informs a structured treatment framework. Instead of a one-size-fits-all approach, strategies can be matched to the suspected dominant mechanism:
* **Blocking Upstream Migraine Pathways:** Using preventive medications (e.g., CGRP monoclonal antibodies, beta-blockers) to reduce the overall migraine burden and its downstream effects on the ear.
* **Protecting the Cochlear Microenvironment:** Investigating otoprotective agents that could shield the inner ear from excitotoxicity and inflammatory damage during attacks.
* **Correcting Central Hypersensitivity:** Employing sound therapy, cognitive behavioral therapy (CBT), or neuromodulation techniques to retrain the hyperactive central auditory pathways. The success of such behavioral interventions can depend on individual factors, a principle also seen in CBT for insomnia where baseline depression predicts outcomes.

## A Call for Integrated, Translational Research

The review, published under DOI 10.1007/s00415-026-13957-0 (PMID: 42371148), is a call to action. It highlights the need for translational research to rigorously test the mechanistic links it outlines. For clinical practice, it advocates for early identification and precise phenotyping of auditory symptoms in migraine patients, fostering collaboration between neurologists and audiologists.

This shift in understanding promises more than just better symptom management. It offers a path to preserving long-term hearing health in a large, vulnerable population by treating the root neurological cause, not just the auditory consequence. As research in this area grows, it will contribute to the broader advances in hearing health that benefit all patients with complex, neurologically-driven auditory conditions.