Tinnitus: Causes, Connection with Migraine, and New Treatment Methods

What is Tinnitus: A View Through the Ages

Tinnitus, or ringing in the ears, is defined as the subjective perception of sounds in the absence of an external source. This phenomenon can manifest as ringing, buzzing, hissing, or other sounds in the ears [1]. Despite the fact that tinnitus is a common symptom of various medical conditions, its history dates back to deep antiquity. Descriptions of symptoms similar to tinnitus can be found in the medical texts of ancient Egypt, Mesopotamia, India, Greece, the Roman Empire, and China, which testifies to its long-standing recognition [2].

Today, tinnitus remains an urgent problem affecting millions of people worldwide. It can significantly reduce quality of life, affecting sleep, concentration, and overall well-being [4].

Causes and Mechanisms of Tinnitus

Tinnitus is not an independent disease, but rather a symptom arising from multiple causes. Its development is often based on disorders in the central nervous system, particularly in the auditory and trigeminal nerve pathways [1].

Among specific mechanisms, the following are distinguished:

• Somatosensory Tinnitus: This subtype of tinnitus is modulated by structures of the cranio-cervical and cranio-mandibular regions, affecting the central auditory pathways. There is a growing body of evidence supporting the link between masseter muscle hyperactivity and somatosensory tinnitus [3].
• Temporomandibular Joint (TMJ) Compromise: A condition in which limitation of lower jaw movement is caused by a lack of space between the mandibular ramus and the upper jaw. This can lead to headaches (often misdiagnosed as migraine), dizziness, and tinnitus [5]. The prevalence of TMJ dysfunctions among patients with chronic headaches is very high, indicating a close interrelation [5].
• Other Factors: In a study conducted in Colombia, the most frequent manifestation of tinnitus was intermittent, constant, sudden-onset, bilateral ringing in the ears. Among the factors associated with the level of discomfort were noise exposure and stress [4].

Tinnitus and Migraine: Common Roots

The close connection between tinnitus and migraine is becoming increasingly evident. Both conditions frequently coexist, which is explained by shared disorders in the central nervous system affecting the auditory and trigeminal nerve pathways [1]. The similarity of patient populations and pathophysiological parallels between tinnitus and migraine strongly indicate their interrelation and potentially shared therapeutic approaches [1].

An important role in this interaction is played by the calcitonin gene-related peptide (CGRP). This peptide participates in inflammatory processes during migraine formation and possibly influences the perceived loudness of tinnitus [1].

Furthermore, migraine is a frequent comorbid condition in epilepsy, with a frequency ranging from 9.3% to 34.7% [6]. Studies also show that peri- and postmenopausal women with severe headaches or migraine symptoms may have an association with tinnitus constancy [7].

Diagnosis and Factors Influencing Discomfort

Interdisciplinary diagnosis is extremely important for effective tinnitus management. Proper diagnosis is necessary to exclude other neurological conditions [2]. In the diagnostic process, doctors collect demographic, clinical, and audiological data, and use questionnaires to assess the level of discomfort and the impact of tinnitus on daily life [4].

Tinnitus often negatively affects patients' quality of life, primarily impacting sleep and concentration [4]. Factors such as noise exposure and stress have been identified as being associated with an increased level of discomfort from tinnitus [4].

Modern Approaches to Tinnitus Treatment

Tinnitus treatment aims to alleviate symptoms and improve quality of life. Given its multifactorial nature, therapeutic approaches can be diverse:

• CGRP-Targeting Medications: These medications are a recent breakthrough in migraine treatment and have proven effective as preventative agents. By blocking the inflammatory role of CGRP in migraine development, they may also hold therapeutic potential for tinnitus by influencing its loudness [1].
• Botulinum Toxin Type A (BoNT/A): For somatosensory tinnitus associated with masseter muscle hyperactivity, BoNT/A is considered a potential therapeutic option. However, its clinical validation still requires further research [3].
• Magnesium: Magnesium supplements (over 200 mg per day) have shown a protective effect against age-related hearing loss and may protect against noise exposure. There is evidence that magnesium may provide additional benefit in sudden hearing loss and tinnitus when combined with standard therapy (corticosteroids, CO2 inhalation). Its use in migraine treatment also points to a potential role in alleviating tinnitus symptoms [8].
• Transcutaneous Auricular Vagus Nerve Stimulation (taVNS): Although this method is primarily investigated for the treatment of epilepsy and migraine, it has shown a reduction in the frequency of migraine attacks [6]. Given the shared neurological pathways between migraine and tinnitus, taVNS may become the subject of future research in the context of tinnitus.
• Treatment of TMJ Compromise: In cases where tinnitus is associated with temporomandibular joint dysfunction, treatment of the underlying dental or maxillofacial condition can lead to symptom relief [5].

It is important to note that the choice of treatment method should be individual and based on careful diagnosis and consultation with a physician.

Sources

1. [1] Potential therapeutic role of calcitonin gene-related peptide medications for tinnitus. https://pubmed.ncbi.nlm.nih.gov/41612541/
2. [2] Tinnitus: well known in antiquity, highly relevant today. https://pubmed.ncbi.nlm.nih.gov/41688620/
3. [3] Masseter Muscle in Somatosensory Tinnitus and Potential Therapeutic Role for Botulinum Toxin Type A: A Scoping Review. https://pubmed.ncbi.nlm.nih.gov/42506730/
4. [4] Clinical and Demographic Characterization of Tinnitus and Factors Associated With Discomfort in a Large Sample of Patients Evaluated in Bogotá, Colombia. https://pubmed.ncbi.nlm.nih.gov/42593239/
5. [5] The Temporomandibular Joint Compromise (TMJC) as a Cause of Otoneurological Symptoms: Headaches, Dizziness and Tinnitus. https://pubmed.ncbi.nlm.nih.gov/42100383/
6. [6] The effects of transcutaneous auricular vagus nerve stimulation in epilepsy comorbid with migraine on the EEG power spectrum: a randomized controlled trial. https://pubmed.ncbi.nlm.nih.gov/41458126/
7. [7] Tinnitus constancy and self-reported severe headache or migraine symptoms in peri- and postmenopausal women: a statistical modeling and machine learning analysis. https://pubmed.ncbi.nlm.nih.gov/41437109/
8. [8] The role of magnesium in otology - A narrative review. https://pubmed.ncbi.nlm.nih.gov/42439044/

The information provided in this article is for informational purposes only and should not be used for self-diagnosis or self-treatment. Always consult a qualified medical professional for an accurate diagnosis and an individualized treatment plan.