Persistent Tinnitus (Ringing in the Ears)
Type: Persistent aura symptom — may last weeks, months, or years. Often bilateral (affecting both sides of vision or both ears). Rare but well-documented.
What is it?
Persistent tinnitus is a chronic ringing, buzzing, humming, or other sound in one or both ears that does not stop after the migraine aura episode resolves. Unlike transient tinnitus that occurs during a brief migraine aura, persistent tinnitus continues for weeks, months, or longer.
What it feels like
The sound can be described as a high-pitched ringing, a low-frequency buzzing, a roaring sensation, or a combination of tones. Some people hear it constantly; others notice it more in quiet environments. The tinnitus may be in one ear or both ears. It can be distracting, particularly when trying to concentrate or sleep, and many people find it frustrating because they cannot turn it off or escape it. The sound is real to the person experiencing it, even though no external source of sound exists.
How patients describe it
“I experience a roaring sound and everything sounds far away for about a day ‘before’ a migraine so it is definitely not due to any medications. It will continue into the migraine sometimes.” — J.
“I’ve had the ringing in my ears, off and on, for over a decade. I asked my own (new) internist who claims to be very experienced with migraines.” — S.
“My husband says that I get very loud (well louder than usual) when I am going to get a migraine. Everything seems so far away.” — R.N.
What makes it worse
Tinnitus may worsen during or shortly after migraine attacks. Loud or sudden sounds, acoustic stimuli, and noisy environments can aggravate it. Stress and anxiety often intensify the perceived loudness or intrusiveness. Fatigue, lack of sleep, and skipped meals may increase awareness of the ringing. Some patients report worsening before or around menstrual cycles.
What may help
Some patients find relief through stress reduction, relaxation techniques, and mindfulness practices. White noise, ambient sounds, or gentle background music can mask the tinnitus and make it less noticeable. Cognitive behavioural therapy approaches can help reduce the emotional distress associated with tinnitus. Adequate sleep and hydration may provide modest improvement. Some patients report that reducing caffeine and alcohol helps.
Related symptoms
- Hypersensitivity to sound
- Vertigo or dizziness
- Hearing changes
- Auditory hallucinations
Clinical note
Persistent tinnitus is reported by 25 of 60 subjects with definite persistent aura. It may be related to basilar-type migraine, which includes tinnitus and hearing loss as characteristic aura symptoms. Evaluation by a neurologist is warranted to exclude other causes such as temporomandibular joint dysfunction or inner ear disorders. A normal brain MRI helps confirm persistent aura without infarction.
If this is the first time you experience these symptoms, or they feel different from previous episodes, seek medical evaluation to rule out other causes.