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Phonophobia in Migraine (sound sensitivity)

Timothy C. Hain, MD, Chicago IL. Page last modified: September 17, 2016

See also: sensory sensitivity in migraine smell sensitivity light sensitivity pressure sensitivity sound sensitivity

Phonophobia means "abnormal sensitivity to sound". It is a common symptom with diverse causes. As is the case with smell and light sensitivity, there is an attempt to distinguish between having a lower threshold, and having greater discomfort.

With sound, it is very clear that persons with migraine do not have better hearing than everyone else, but rather they can have greater discomfort than everyone else for loud noises.

The technology of measurement of both thresholds and discomfort is very well worked out for sound, where assessment of "LDL" or loudness discomfort levels are routine when fitting hearing aids.

One would think that for all of these situations, one should "adjust" the discomfort level for the threshold -- or in other words, attempt to differentiate between the input to the brain and the response to the brain. For hearing, this can be done by subtracting the pure tone threshold from the LDL.

Triggering of migraine with sounds

Loud noise is often reported by our patients to cause migraines. However, the headache literature seems to be rather unsympathetic to the general concept that noise is a migraine trigger.

Schulte et al (2015) suggested that rather than sound being a trigger, sound sensitivity was part of a "premonitory phase" of migraine.

Martin et al (2006) suggest that migraine patients cause their own sensitivity by avoiding loud noises, and seemed to propose that migraine patients need to experience more loud noise. We are dubious.

Somewhat similarly, Andersson et al (2005) suggests (without any proof) that psychotherapy might be a useful treatment for hyperacusis of any variety. Again, while we have nothing against psychotherapy, we are dubious that this is the answer for migraine sound sensivity.

Rojahn and Gerhards (1986) suggested that migraine subjects showed a "higher level of general stress sensitivity", and implied that their greater noise "aversiveness" was in essence a personality characteristic.

Sound discomfort as a diagnostic criteria for migraine

Ashkenazi et al (2009) reported "sound aversion thresholds", which appear to be "LDL" measurements under a different name. In 60 migraine patients, the mean SAT averaged at 1000, 4000 and 8000, was roughly 15 dB lower than 52 non-migraine patients. This was between attacks. During migraines, the SAT was also about 15 dB lower. We are surprised that the gap did not become larger during migraines.

Vingen et al (1998) also reported more sensitivity to "sound-induced discomfort".

Main et al (1997) similarly reported more discomfort to sound both outside of attacks as while having a migraine.

Woodehouse and Drummond (1993) reported that both auditory and visual discomfort thresholds were reduced during attacks in migraines. They stated that the findings do not support the view that phonophobia is a manifestation of loudness recruitment.

In a related measure, Joffily et al (2016) reported that women with migraine and phonophobia exhibited deficits in OAE suppression, suggesting a disorder of their ability to suppress outer hair cell responses. As OAE's are used to dampen sound, this study in essence says that migraine patients keep their outer hair cells turned on - -which would be a reasonable thing to do if one was troubled by loud noises.

Intensity of sound perception in migraine subjects.

There are no claims that migraine subjects can hear better than non-migraine subjects.

 

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Copyright September 17, 2016 , Timothy C. Hain, M.D. All rights reserved. Last saved on September 17, 2016