A New Category of Headache?

RESEARCH UPDATE

People with migraine may be at increased risk for cochlear disorders, especially tinnitus, according to a study published in JAMA Otolaryngology-Head & Neck Surgery.¹ Based on these results, the authors suggested a new category of migraine called “cochlear migraine.”

“In this large-scale cohort study, we found that patients with a history of migraine had a tendency to develop cochlear disorders, especially tinnitus, defined in one study as "the perception of a sound with a lack of an evident external stimulus to that sound."² The results of this study supported the new concept and/or presence of cochlear migraine,” wrote first author Juen-Haur Hwang, MD, PhD, of Tzu Chi University (Hualien, Taiwan), and colleagues.

While many patients with migraine have headaches, symptoms of migraine can also occur without head pain and can affect vision, hearing, smell, and touch. Hyperacusis, or increased sensitivity to sound, can be a symptom of migraine that is also associated with disorders of the cochlea, which is found in the inner ear. But whether migraine is associated with cochlear disorders has been unclear.

To evaluate the possible link between migraine and cochlear disorders, researchers used claims data from the Taiwan Longitudinal Health Insurance Database. The analysis included 1056 individuals newly diagnosed with migraine between January 1996 and December 2012 (36.4% men, mean age 36.7 years). Researchers matched migraineurs to 4224 controls and used propensity score matching to control for baseline differences such as age, sex, and comorbidities. Mean follow-up was a little over six years.

Key results:

• Higher incidence of cochlear disorders with migraine (12.2%) vs without migraine (5.5%)

-Almost 3 times increased risk of cochlear disorders with migraine vs without migraine (adjusted HR 2.71)

Results adjusted for comorbidities, oral contraceptive use, pregnancy, menopause, region of residence, urbanization, and socioeconomic status

• Compared with no migraine, migraine was linked to:

-Over 3 times higher risk of tinnitus (HR 3.30)

-22% higher risk of sudden deafness (HR 1.22)

The authors mentioned that the link between migraine and tinnitus could indicate a central process in the brain, rather than a problem in the cochlea. Further studies using audiometry would be needed to assess the underlying cause. Regardless, they pointed out that the results still suggest a link between migraine and tinnitus.

They also mentioned several potential limitations. The study identified individuals with migraine as those who had two or more ICD-9 codes for migraine within three months, which may have identified only people with more severe migraine. So the results may not apply to all individuals who suffer from migraine.

Take home points

• People with migraine had almost three times increased risk of cochlear disorders, compared with people without migraine

• Migraine was linked to specific cochlear disorders, especially tinnitus

• Authors propose “cochlear migraine” as a new migraine category

References:

1. Hwang JH, Tsai SJ, Liu TC, et al. Association of Tinnitus and Other Cochlear Disorders With a History of Migraines. JAMA Otolaryngol Head Neck Surg. 2018;144:712-717.

2. Kalle S, Schlee W, Pryss RC, et al. Review of Smart Services for Tinnitus Self-Help, Diagnostics and Treatments. Front Neurosci. 2018;20;12:541.