Migraines and Hearing Disorders: The Auditory Link

**A systemic review in *Journal of Neurology* synthesizes the most current evidence linking migraine to a range of auditory dysfunctions. The authors, led by Wandi Xu, Ni Zhai, and Jingyu Chen, argue that migraine operates as a “systemic disorder of multisensory sensitization,” with auditory symptoms being a core, often overlooked, component. Epidemiological data shows that 15% to 49% of migraine patients experience comorbid auditory symptoms like tinnitus or hyperacusis, and nearly two-thirds show objective abnormalities on auditory electrophysiological tests. The research, which examines epidemiological, audiological, and pathophysiological data, moves beyond simple comorbidity to propose a unified, three-axis model explaining the connection.**

How the Research Was Conducted

This work is a comprehensive narrative review, not a new clinical trial. The authors, a cross-disciplinary team from otolaryngology and physiology departments in China, systematically analyzed and synthesized previously published literature. Their goal was to consolidate epidemiological data, audiological findings, and pathophysiological theories to build a cohesive model linking migraine and auditory dysfunction. By reviewing a wide body of evidence, they aimed to clarify the mechanistic links that have often been described in isolation. The review’s strength lies in its integration of data from peripheral ear physiology to central brain network theories.

Three Interacting Axes Explain the Brain-Ear Link

The central contribution of this review is a proposed pathogenic framework built on three interconnected axes. The first axis involves anatomical and hydrodynamic vulnerabilities. The authors note that the inner ear’s delicate blood supply and its connection to cerebrospinal fluid dynamics make it susceptible to the vascular changes and inflammation inherent to migraine. This can lead to localized microvascular ischemia and disrupted fluid exchange, damaging cochlear structures.

The second axis focuses on localized neurochemical imbalances within the inner ear itself. Migraine-related processes, such as glutamate excitotoxicity, the release of neuropeptides like CGRP, and innate immune system activation, can directly disrupt the cochlea’s microenvironment. This creates a state of peripheral auditory sensitization, potentially triggering or worsening symptoms like tinnitus and hyperacusis.

The third and perhaps most significant axis is central sensitization. Migraine primes the central nervous system to be hyper-responsive. In the auditory domain, this manifests as impaired efferent feedback from the brain to the ear (reducing the ability to “tune out” background noise) and thalamocortical dysrhythmia—a malfunction in how sound signals are processed and filtered by the brain. This central component helps explain why sound tolerance issues like hyperacusis and misophonia are so common. It aligns with other research showing how brain structure predicts tinnitus treatment success, emphasizing the central nervous system’s role in auditory perception.

Practical Implications for Diagnosis and Management

This mechanistic model has direct clinical implications. For diagnosis, it argues for more consistent and comprehensive audiological assessment in migraine patients. Since standard pure-tone audiometry may be normal, tests like otoacoustic emissions (OAEs) and auditory brainstem responses (ABRs), which can reveal the “hidden” dysfunctions described, should be considered. Our site’s article on migraine and hidden hearing loss explores this specific diagnostic angle in detail.

For treatment, the authors categorize strategies by their target axis. This moves away from a one-size-fits-all approach. Blocking upstream migraine pathways with established or new migraine medications (e.g., CGRP antagonists) could prevent the cascade that affects the ear. Protecting the cochlear microenvironment involves exploring treatments that mitigate excitotoxicity or inflammation locally, an area where research into nanocarriers for otic drug delivery could become highly relevant. Finally, correcting central hypersensitivity points to neuromodulation therapies, cognitive behavioral approaches, and sound therapy to retrain maladaptive brain networks.

A Call for Cross-Disciplinary Care

The review concludes that optimal care requires breaking down silos between neurologists, otolaryngologists, and audiologists. Understanding migraine as a multisensory disorder means auditory symptoms should be actively queried in migraine clinics, and migraine history should be thoroughly investigated in audiology and tinnitus practices. This integrated view is part of a broader shift toward integrated auditory health.

By providing this unified framework, Xu, Zhai, Chen, and colleagues offer a roadmap for future research and a rationale for more precise, mechanism-based treatments. Their work makes a strong case that for a significant subset of patients, treating the migraine may be fundamental to treating the tinnitus, hyperacusis, or hearing discomfort they experience.

Source: Xu W, Zhai N, Chen J, et al. Migraine and auditory dysfunction: beyond comorbidity. J Neurol. 2026;273(7):433. doi:10.1007/s00415-026-13957-0. PMID: 42371148.