Hearing Symptoms in Migrainous Infarction

Abstract

Background In case reports, migraine headaches have been associated with fluctuating low-frequency hearing loss and sudden, unilateral hearing loss. Auditory symptoms associated with migrainous infarction have not previously been emphasized.

Objective To describe migrainous infarction presenting with acute auditory symptoms.

Design Case reports.

Setting Tertiary care hospitals.

Patients A 40-year-old man with a history of migraine suddenly developed bilateral hearing loss associated with severe, throbbing, occipital headache, tinnitus, vertigo, speech disturbance, and right hemiparesis. An early audiogram showed profound, down-sloping, sensorineural-type hearing loss bilaterally. Sixteen days later, a follow-up pure tone audiogram documented marked improvement in both sides to a pure tone average of 30 dB. Right hemiparesis and dysarthria also improved steadily for 2 months. A 25-year-old woman with a history of migraine with aura suddenly developed hyperacusis, unilateral hearing loss, and migraine headache early in migrainous infarction. Magnetic resonance imaging documented infarcts in the pons and cerebellum.

Conclusions In these patients, acute auditory symptoms are a part of the prodrome of migrainous infarction. We speculate that these symptoms may have resulted from migraine-associated vasospasm. Migrainous infarction should be considered in the differential diagnosis of acute auditory symptoms, including sudden, bilateral hearing loss.

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MIGRAINE HAS been reported to cause sudden sensorineural hearing loss (SNHL).1,2 When this occurs without acute headache in a migraineur, it is questionable whether the SNHL is related to migraine. We know of only a few reports1- 4 of sudden auditory symptoms attributed to migraine. We describe 2 patients diagnosed as having migrainous infarction, each of whom presented with acute auditory symptoms (AAS)—one with bilateral sudden hearing loss, the other with tinnitus, hyperacusis, and unilateral hearing loss. Both had characteristic features of migraine at the ictus as well as a history consistent with complicated migraine.