In large studies, people with migraine had about 1.4 to 3.3 times the odds or rate of tinnitus, but cause is unproven, and the proposed explanation, shared oversensitivity of brain and inner ear, remains a hypothesis.
This article covers migraine without vertigo attacks. With vertigo, vestibular migraine is the more specific diagnosis; tinnitus that whooshes with your pulse is pulsatile tinnitus, which has a different workup. Tinnitus alongside constant static across your vision is covered in visual snow syndrome and tinnitus.
How often migraine and tinnitus turn up together
The link appears in very different groups:
- US adults. A national health survey (NHANES) covered 12,962 people aged 18 to 65. Tinnitus was reported by 34.6% of those with migraine against 16.9% of those without, an adjusted odds ratio of 2.1. The survey asked about "severe headache or migraine", so the group includes other severe headaches, as the authors acknowledge.
- French students. Among 5,729 students with a mean age of 20.8, tinnitus was reported by 8.9% of those with migraine. The adjusted odds ratio was 1.77, higher with aura (2.10) than without (1.51), while other headaches did not reach significance (1.38, confidence interval 0.98 to 1.92).
- Tinnitus clinics. From the other direction, 60 of 227 consecutive tinnitus patients at a Japanese clinic (26.4%) had migraine, and a 2024 systematic review found two studies reporting migraine in 10.1% and 22.5% of people with tinnitus.
That review gathered six observational studies with 26,166 participants; most showed an association, but, as the authors note, six studies is a small base.
Does migraine come first?
The stronger test is whether migraine comes before new tinnitus.
- A Taiwanese insurance-claims study followed 1,056 people with migraine and 4,224 matched controls. The adjusted hazard ratio for tinnitus was 3.30; cochlear disorders overall affected 12.2% against 5.5% over follow-up.
- The Busselton Healthy Ageing Study in Australia surveyed 3,863 people born between 1946 and 1964 twice, six years apart; the six-year incidence of tinnitus was 12.1%. Self-reported, doctor-diagnosed migraine was linked to higher odds of new tinnitus once age and sex were accounted for, an odds ratio of 1.44 (95% CI 1.08 to 1.91).
- A 2025 Mendelian randomisation study, which uses genetic variants linked to migraine to reduce confounding, reported an odds ratio of 1.516 for tinnitus. It is a single study.
Two reasons for caution
The one pooled estimate was inconclusive. A 2023 meta-analysis of tinnitus risk factors restricted itself to case-control and cohort studies, the designs that say more about cause. For migraine it could pool only two. The combined relative risk was 2.11, but the 95% confidence interval ran from 0.93 to 4.79 and the two studies' estimates differed widely (I² = 93%), so the review listed migraine among factors with no demonstrated association.
Other headaches show a similar link. In the same Taiwanese database, an overlapping team compared 43,294 people with headaches that were not migraine with people who had no headache at all, and found an adjusted hazard ratio for tinnitus of 3.05, close to the 3.30 for migraine, though the migraine study's controls simply lacked migraine, so the figures are not strictly comparable. That team cautions that some migraine may have been coded as plain "headache", so their conclusions should be read conservatively. That makes it harder to say the association belongs to migraine specifically, although the French data, where only migraine reached significance and aura strengthened it, point the other way.
What might explain the link
The main proposals involve the brain as well as the ear. A 2022 review suggests migraine and tinnitus may share a mechanism in the central nervous system: activation of the trigeminal nerve, which carries head pain, and a likely general oversensitivity of the brain, often called central sensitisation. It notes that CGRP, a signalling molecule implicated in migraine, is present in the inner ear and balance organs. A 2026 review describes migraine as a disorder of multisensory sensitisation, reports that 15% to 49% of people with migraine have hearing-related symptoms, and sets out a continuum of likely causes, from disturbed blood supply and chemistry in the inner ear to central sensitisation in the brain.
A 2023 hypothesis paper sets out how this might produce tinnitus that rises and falls with attacks: trigeminal activation could change the sensitivity of the auditory cortex, and inflammation could make blood vessels in the brain and inner ear leakier. The two conditions also share triggers, among them stress, poor sleep and dietary factors.
Some findings fit sensitisation better than hearing damage:
- In a 2025 series of 50 people with vestibular migraine, 38 had tinnitus, and it was not associated with hearing loss: hearing thresholds were similar with or without it.
- At one Taiwanese hospital, tinnitus patients with migraine or vestibular migraine had better average hearing than those without, 22.2 against 29.5 dB in the right ear. The abstract does not say whether age was accounted for, which matters because hearing declines with age.
- Sound sensitivity travels with both. NICE's headache guideline lists unusual sensitivity to sound among the features of migraine, and in the Busselton study hyperacusis was also a risk factor for new tinnitus.
Two cautions apply. The mechanism is inferred, not observed: the 2022 review and the hypothesis paper both say it still needs working out. And much of the case, including the hypothesis paper, the US survey analysis, the 2022 review and the trial described below, involves authors from one centre, the University of California, Irvine. Independent replication would carry more weight.
When tinnitus rises and falls with attacks
- At a Japanese tinnitus clinic, 27 of the 60 patients with migraine (45.0%) said their tinnitus worsened during attacks, and those 27 scored higher than the rest for tinnitus handicap, hearing handicap, anxiety and depression. The migraine group as a whole had tinnitus handicap scores similar to the 167 patients without migraine, but higher anxiety and depression scores.
- At a German tertiary clinic, 489 of 1,817 tinnitus patients reported headaches. Of the 193 whose questionnaires were analysed, 45% had migraine, and 43.4% said worsening tinnitus and worsening headache went together. The tinnitus side tended to match the headache side.
- The Taiwanese hospital study disagreed with the Japanese one on overall burden: migraine or vestibular migraine was the only factor linked to higher Tinnitus Handicap Inventory scores, with an odds ratio of 19.41. That very large figure comes from the 125 of 298 patients who completed the questionnaire.
So whether migraine makes tinnitus more bothersome overall is unsettled; in the Busselton study, migraine did not predict changes in existing tinnitus's impact on daily life over six years. What recurs is a group of people whose tinnitus tracks their attacks and who are more troubled by it, with more anxiety as well.
A record will show whether your tinnitus follows your migraines. NICE's headache guideline suggests a diary kept for at least 8 weeks, recording attacks, other symptoms, medicines taken and possible triggers. The flare-up journal lets you log tinnitus alongside, and tinnitus flare-ups covers common triggers.
Migraine medicines and tinnitus
For attacks, NICE recommends a triptan combined with an NSAID or paracetamol, or a triptan, an NSAID, aspirin (900 mg) or paracetamol alone. For prevention it suggests propranolol, topiramate or amitriptyline. Some of these have their own link to tinnitus.
- Triptans, CGRP-blocking drugs and preventives. Among 47,615 tinnitus-related reports in the US FDA's adverse event database, 183 involved triptans and 345 CGRP inhibitors. There were signals for every triptan except sumatriptan, and for four of the seven CGRP inhibitors analysed (fremanezumab, galcanezumab, erenumab and ubrogepant), but not eptinezumab, atogepant or rimegepant. The preventives propranolol, a beta-blocker, and topiramate also showed signals. Voluntary reports show a signal, not a rate, and the authors call the findings preliminary.
- Painkillers. In the Nurses' Health Study II, which followed 69,455 women, frequent NSAID or paracetamol (acetaminophen) use was linked to a modestly higher risk of persistent tinnitus, a hazard ratio of 1.18 for paracetamol on 6 to 7 days a week. Frequent low-dose aspirin was not linked, but frequent moderate-dose aspirin was, in women under 60. The study did not know why people took them, and these are the same painkillers NICE lists for migraine, so the two are hard to separate. Aspirin, NSAIDs and tinnitus covers the doses.
If a medicine seems to have started or worsened your tinnitus, raise it with the prescriber rather than stopping it yourself; the medication checker can help you prepare the question.
Does treating migraine quieten tinnitus?
Not on current evidence, because it has barely been tested.
One placebo-controlled trial. Researchers at UC Irvine randomised 78 adults with moderate to severe tinnitus, who did not need to have migraine, to nortriptyline with topiramate, verapamil with paroxetine, or placebo for eight weeks, choosing the pairs for their migraine-preventing effect. Both drug groups improved on the Tinnitus Functional Index against their own starting scores, from 58.4 to 46.3 and from 54.6 to 42.2, but placebo also fell, from 51.2 to 45.2, and the difference between the arms was not significant (p = .265). A later analysis reported that 42% and 41% of the drug groups reached a clinically important improvement, but gave no placebo figure alongside. The patterns that make a weak tinnitus result look strong uses the trial as a worked example.
One trial registered. COMPACT-PM, at Stanford, plans to randomise about 120 adults with tinnitus and a history of migraine or another headache disorder to an anti-CGRP drug or a conventional migraine preventive for 24 weeks. With no placebo arm and no blinding, it can compare the two classes but not either against nothing. When registered in June 2026 it was not yet recruiting; where tinnitus research is headed tracks it.
Uncontrolled reports. Among 1,204 patients with migraine at one US centre, pulsatile tinnitus with no other explanation was found in 1.9%, and 11 of the 16 treated for migraine reported improvement or resolution. The UC Irvine group's published management approach, based partly on its own clinical observations, starts with lifestyle, diet, vitamin B2 and magnesium, then drugs such as nortriptyline, topiramate or verapamil; it is a clinical approach, not a tested one.
Treatments for tinnitus distress, such as CBT, do not depend on settling the migraine question; the treatment comparison sets them side by side.
When headache and tinnitus are something else
Idiopathic intracranial hypertension is the one to know about: raised pressure around the brain with no identifiable cause. A 2022 review lists its primary symptoms as headache, vision loss and pulsatile tinnitus. A 2021 review adds that its headache frequently looks like migraine and often overlaps with chronic migraine, so it should be considered when chronic headache is assessed, because visual loss from swelling at the optic nerve head may be irreversible. Whooshing tinnitus in time with your pulse, together with headaches or any change in vision, is the combination to have assessed promptly; intracranial hypertension and tinnitus covers the diagnosis.
Other warning signs that should not be put down to migraine come from NICE's headache and tinnitus guidelines:
- A headache that reaches its worst within five minutes, changes with posture, or is triggered by coughing, sneezing or exercise; or a worsening headache with fever.
- Neurological symptoms that do not fit aura, which typically develops over at least 5 minutes, lasts 5 to 60 minutes and fully reverses. Sudden weakness, facial drooping or suspected stroke alongside tinnitus calls for immediate referral.
- Hearing loss that developed over three days or less, which NICE asks to be seen within 24 hours if it began in the past 30 days, or within 2 weeks if earlier; sudden hearing loss explains why.
- Persistent pulsatile tinnitus, for which NICE says referral should be considered.
The when to seek care tool walks through the same questions. If none apply, tell whoever treats your migraine about the tinnitus, and whoever assesses your tinnitus about the migraine, including when each started and whether they move together.