Recent research has revealed that atypical migraine can influence tinnitus in some individuals. Some patients report significant improvement in tinnitus when treated with migraine-specific therapies. But how can someone know whether migraine is a factor in their tinnitus, and what treatments might help?

Understanding migraine beyond headaches

Migraine is a complex neurological disorder, not just a severe headache. Some people experience migraine without ever having a headache. It is thought that inherited variations in neuronal ion channels make the brain of a migraineur more sensitive to triggers like stress, sleep changes, hormonal shifts, certain foods, and sensory overload. These triggers can push certain brain activity past a threshold, producing abnormal electrical patterns in the brain and activating the trigeminal nerve, which supplies sensation to the face, ears, jaw, and brain lining. These alternations manifest as a migraine attack.

During migraine attacks, trigeminal nerve activation results in the release of chemical mediators that cause inflammation and altered blood flow in the brain. While headaches are common, symptoms can also include nausea, light and sound sensitivity, dizziness, and ear-related symptoms.

For a person with migraine susceptibility, the frequency of their migraine attacks can vary widely depending on their diet, sleep quality, hormonal status, and stress level, as all of these factors can push the brain activity level over one’s individual migraine threshold. “If this has a genetic substrate, then you retain this susceptibility through your entire lifetime. Now what tips you over into migraine activity could be different during one period of your life compared to another period of your life,” reports Dr. Michael Teixido, a neurotologist based in Delaware who holds academic appointments at both the University of Pennsylvania and Thomas Jefferson University and has written and spoken extensively about the head and neck manifestations of migraine. Some people have migraine attacks several times a week and others can experience decades without a single episode.

In addition, an individual’s migraine symptoms can change over the course of their life. Some experience classic headaches early in life, which may later evolve into atypical symptoms, including ear pressure, dizziness/vertigo, and fluctuating tinnitus.

The link between migraine and tinnitus

But how are migraine and tinnitus related? Well, clinical studies document that 26-47 percent of tinnitus patients also report migraines, and about 35 percent of migraineurs experience tinnitus. Also, as mentioned earlier, the trigeminal nerve becomes activated during migraine activity. It has been observed that trigeminal nerve fibers actually innervate the blood vessels of the inner ear so, it is theorized, that during migraine activity, neurogenic inflammation or blood flow changes may directly affect the cochlea, triggering ear symptoms including tinnitus. Migraineurs also display interictal differences between attacks, including reduced habituation (difficulty filtering irrelevant stimuli) and sensory hypersensitivity, both relevant to tinnitus. “A key feature of migraine is that it amplifies sensory hypersensitivity. Tinnitus itself is the result of hyperactive auditory neurons in the brain. So when the migraine process is active, it turns the already existing hearing nerve hyperactivity into overdrive, amplifying the tinnitus signal,” says Dr. Hamid Djalilian, a professor of otolaryngology and neurosurgery at the University of California Irvine who has authored several studies and a book on this topic. Shared dietary/environmental triggers, sympathetic nervous system hyperactivity, altered brainstem and thalamic processing, and tension in facial, jaw, and neck muscles further link the two conditions.

Recognizing migraine-related tinnitus

Most people that have classic nonpulsatile tinnitus related to hearing loss (not influenced by migraine) report a generally constant sound that may be more noticeable in quiet environments, but does not otherwise change significantly over time. In contrast, tinnitus influenced by migraine often fluctuates significantly over a typical week. It may worsen with stress, sleep disruption, noise exposure, or weather changes. Other clues include ear pressure or pain, dizziness, vertigo, fluctuating hearing, sound sensitivity, neck or jaw tension, and personal or family history of migraine. “Migraine is fundamentally a sensory processing disorder. With migraine headaches, the sensory symptom is pain. With vestibular migraine, it’s vertigo. With migraine tinnitus, it’s loud ringing,” explains Dr. Djalilian.

Migraine treatment can reduce tinnitus.

Otolaryngologists and neurologists are observing that treating migraine directly can reduce tinnitus severity. The therapeutic approaches for migraine fall into three general categories: migraine trigger avoidance/minimization, nutritional supplements, and medications. “We’re trying to get the brain activity below the threshold: We elevate the threshold with medicines. We lower that brain activity with lifestyle changes,” states Dr. Djalilian.

1. Avoiding or minimizing triggers

Common migraine triggers include:

• Stress (physical or emotional)
• Hormonal changes (menstrual cycle, menopause, pregnancy, and hormone therapy)
• Sleep disturbances (too much, too little, or interrupted)
• Diet (skipping meals, dehydration, caffeine, chocolate, red wine, aged cheeses, and MSG)
• Sensory overload (bright lights, loud sounds, strong odors, motion, and barometric changes)

Addressing triggers (especially prioritizing consistent sleep and stress management through exercise or mindfulness) can reduce migraine severity.

2. Nutritional supplements

Supplements that may help raise migraine threshold include:

• Riboflavin (vitamin B2): Up to 200 mg twice daily
• Magnesium: Up to 400 mg twice daily
• Coenzyme Q10: Up to 100 mg three times daily
• Melatonin: Up to 3 mg at bedtime

Consult a physician before starting supplements.

3. Medications

When lifestyle and supplements are insufficient, medications targeting brain excitability can be effective. These include classes of drugs that are also used for high blood pressure, anxiety, depression, or seizures. Finding the right medication and dose often requires trial and error. “We never know ahead of time what is going to work. My experience is that we have five or six classes of medications that we typically have in our toolkit. It usually takes about 2.3 tries on average to get the right medicine,” says Dr. Teixido.

Migraine therapy may not eliminate tinnitus entirely but can reduce fluctuations and peak severity, improving quality of life. Patients are noticing meaningful improvements:

• Teresa Bennett: “My migraines and tinnitus are linked and go together. When I get one, I get the other. When I get on a medication that decreases my migraines, the tinnitus is no longer noticeable.”
• Holly Clark: “During a migraine episode, my tinnitus goes from my baseline to overwhelmingly loud. Ajovy [fremanezumab, a migraine prophylactic medication] didn’t reduce the number of migraines I had, but it significantly reduced their intensity and duration, including the severity of the tinnitus.”

Dietary guidance

A migraine-friendly diet can help:

• Caffeine:
  • Foods to avoid: >2 servings/day
  • Alternatives: Herbal tea, water, and juice
• Snacks/desserts:
  • Foods to avoid: Chocolate and nuts
  • Alternatives: Ice cream, cakes, and safe fruits
• Alcohol:
  • Foods to avoid: Red wine and beer
  • Alternatives: Nonalcoholic drinks; vodka is tolerated best
• Dairy:
  • Foods to avoid: Aged cheeses and buttermilk
  • Alternatives: Cream cheese, cottage cheese, and egg substitute
• Grains:
  • Foods to avoid: Fresh bakery breads
  • Alternatives: Packaged breads and bagels
• Meats:
  • Foods to avoid: Processed meats
  • Alternatives: Fresh meats and seafood
• MSG:
  • Foods to avoid: Soy sauce and canned soups
  • Alternatives: Table salt, pepper, and safe spices
• Sweeteners:
  • Foods to avoid: Aspartame, saccharin, and sucralose
  • Alternatives: Natural sugars in moderation
• Vegetables:
  • Foods to avoid: Certain beans, onions, and olives
  • Alternatives: Broccoli, carrots, spinach, and tomatoes
• Fruits:
  • Foods to avoid: Avocado, figs, papaya, and red plums
  • Alternatives: Apples, berries, peaches, and pears

Conclusion

In a subset of tinnitus sufferers, migraine can modulate symptom severity. Recognizing migraine-related tinnitus opens the door to a previously unrecognized treatment pathway. For many patients, migraine-specific treatment can reduce tinnitus intensity and variability, significantly improving quality of life.

Brian F. Worden is a board-certified otolaryngologist and the creator of Alleviate Integrative Tinnitus Therapy. He earned his medical degree from the University of California, San Francisco, where he was elected to the Alpha Omega Alpha medical honor society. During medical school, he completed a research fellowship at the National Institutes of Health, funded by the Howard Hughes Medical Institute. Dr. Worden then trained in otolaryngology-head and neck surgery at Stanford University, completing his residency in 2009. While practicing in Los Angeles, he identified the need for more effective treatment options for intrusive tinnitus. In response, he developed Alleviate Integrative Tinnitus Therapy, an evidence-based program delivered through an app and online platform. His scholarly work has been published in Cancer Research, Archives of Otolaryngology-Head and Neck Surgery, and Tinnitus Today Magazine, where his 2025 article, “Is Your Tinnitus a Symptom of Migraine? Here’s What You Need to Know,” highlights the connection between tinnitus and migraine. Updates and resources can be found on Facebook, Instagram, LinkedIn, and YouTube.