The irritating buzzing and ringing in the ears that signifies an attack of tinnitus is a common issue, affecting around 50 million Americans. Interestingly, it’s not an independent medical condition but a symptom of several other problems, including many types of headache disorders. Patients often mistake migraines for inner ear problems and vice versa, partly because both can cause tinnitus. Here are the differences between tinnitus and migraine, and details on how they are connected.

Causes of Tinnitus

Up to 200 different health disorders can trigger tinnitus, according to the American Tinnitus Association, and some of the most common ones include:

• Hearing loss, which is either age- or noise-related
• An accumulation of ear wax
• Trauma to the head or neck
• Temporomandibular disorders (TMD)
• The use of certain medications, such as non-steroidal anti-inflammatories and antibiotics
• Sinusitis or nasal congestion.

Many of these have simple solutions, and may have nothing to do with your migraines, or your doctor could diagnose primary tinnitus unrelated to any other condition. Keeping a detailed migraine diary will enable you to track any patterns and triggers, and you might identify coincidences between the tinnitus attacks and your migraines.

Inner Ear Problems

Tinnitus is just one of a range of inner ear problems experienced by both migraineurs and non-migraine patients. Other medical disorders with inner ear symptoms include vestibular neuritis and labyrinthitis, which are caused by infection of either the inner ear or the nerves that connect it to the brain. The accompanying inflammation hinders the transmission of information between the two, resulting in vision or hearing challenges, tinnitus, vertigo or balance problems. These infections are typically viral or bacterial, but differ from the type of middle ear infection that usually affects children.

The Migraine and Tinnitus Connection

While science has not identified a cause-and-effect relationship between tinnitus and migraine, there are a number of connections that have been recorded by patients over the years.

1. Sufferers often experience tinnitus and headache laterality, which means the pain and the tinnitus occur on the same side of the head, and when one condition worsened the other did too.
2. A 2016 study by the American Headache Society suggested central sensitization could be the reason why more than 1,600 participants with a history of migraines were more likely to experience tinnitus than those without. Central sensitization is when you feel pain from things that shouldn’t hurt, such as a regular touch.
3. Patients suffering from migraine with aura or migraine with brainstem aura typically have a higher incidence of tinnitus, particularly during the prodrome phase, than those who get migraine without aura. For this reason, it’s thought tinnitus could be an auditory form of aura.
4. Tinnitus is often accompanied by photophobia, nausea and vomiting, which are all typical symptoms experienced during migraine attacks.  
5. Patients who develop vertigo or dizziness with tinnitus during a migraine attack might be experiencing Migraine Associated Vertigo.

While none of these coincidences indicates conclusively that your migraines and tinnitus are linked, tell your migraine doctor if you suspect there may be a relationship between the two. Oftentimes, patients discuss their tinnitus with the family physician while consulting with a migraine doctor about their headaches, and unless your practitioners know about both they won’t be in a position to diagnose a connection between the conditions.

Treatment Options for Tinnitus

Once your doctor identifies whether your tinnitus and migraines are related, it might be possible to relieve either one or both conditions with the right course of treatment. For non-migraine related tinnitus, treatment options include:

• Hearing aids, for patients with hearing-loss related tinnitus
• Sound therapies, to balance the reaction to tinnitus
• Habituation Retraining Therapy (HRT) or Cognitive Behavioral Therapy (CBT), which empower patients to control their response to conditions like tinnitus
• Drug therapies, to control stress, anxiety and depression that contribute to tinnitus
• Condition-specific treatments for issues such as TMD/TMJ
• Medication to treat any infections of the inner ear, followed by exercises to rehabilitate the vestibular connection to the brain.

In the case of tinnitus related to migraine with aura, combining the treatment for migraine with practical methods to relieve the tinnitus may give you greater relief. Regardless of the treatment your doctors recommend, lifestyle changes such as adopting a low salt diet and avoiding alcohol or caffeine are likely to be beneficial.