{"title":"Migraine impairs the auditory protective mechanism: a potential biomarker.","authors":"Muchen Huang, Guanxia Xiong, Xianren Wang","doi":"10.1186/s10194-026-02414-y","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Migraine is a prevalent neurological disorder frequently accompanied by auditory symptoms such as tinnitus and hyperacusis. While their associations suggest shared neural mechanisms, objective evidence regarding the specific involvement of brainstem-mediated auditory efferent pathways in migraine remains limited. The medial olivocochlear reflex (MOCR) and the middle ear muscle reflex (MEMR) are two key auditory protective mechanisms, yet their integrity in migraine patients remains to be investigated. This study aimed to evaluate the functional integrity of the MOCR and MEMR pathways in migraine patients with and without comorbid tinnitus.</p><p><strong>Methods: </strong>In this cross-sectional study, 143 participants were classified into four groups based on strict diagnostic criteria: healthy controls (HC, n = 44), tinnitus-only (T, n = 49), migraine-only (M, n = 25), and migraine with tinnitus (TM, n = 25). Groups were matched for age, sex, and hearing thresholds. All participants underwent comprehensive audiological assessments, including pure-tone audiometry, ipsilateral and contralateral acoustic reflex threshold (ART) testing to assess MEMR function, and distortion-product otoacoustic emissions (DPOAE) with contralateral suppression evaluation to assess MOCR function.</p><p><strong>Results: </strong>The migraine group (M) demonstrated significantly elevated contralateral ART (indicating MEMR impairment) at 500 Hz and 1000 Hz (p < 0.001) and globally reduced DPOAE suppression (reflecting MOCR dysfunction) (p < 0.001) compared to healthy controls. The TM group exhibited a similar pattern of MOCR and MEMR dysfunction to the M group, with no significant additive effect from tinnitus comorbidity. A clear gradient of contralateral ART impairment was observed across groups: HC < T < (M ≈ TM). Ipsilateral ART results showed less consistent abnormalities.</p><p><strong>Conclusion: </strong>Migraine may be associated with specific dysfunction of brainstem auditory efferent pathways, particularly affecting both MOCR and MEMR systems, independent of peripheral hearing status. The convergent abnormalities in migraine patients with and without tinnitus indicate that auditory efferent disruption may be an intrinsic component of migraine pathophysiology. These findings support the potential of contralateral ART as an objective biomarker of migraine-related auditory pathway involvement, highlighting the clinical value of auditory assessment in migraine management and providing insights for the development of targeted therapeutic strategies.</p>","PeriodicalId":16013,"journal":{"name":"Journal of Headache and Pain","volume":" ","pages":""},"PeriodicalIF":8.7000,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13471409/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Headache and Pain","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s10194-026-02414-y","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Migraine is a prevalent neurological disorder frequently accompanied by auditory symptoms such as tinnitus and hyperacusis. While their associations suggest shared neural mechanisms, objective evidence regarding the specific involvement of brainstem-mediated auditory efferent pathways in migraine remains limited. The medial olivocochlear reflex (MOCR) and the middle ear muscle reflex (MEMR) are two key auditory protective mechanisms, yet their integrity in migraine patients remains to be investigated. This study aimed to evaluate the functional integrity of the MOCR and MEMR pathways in migraine patients with and without comorbid tinnitus.
Methods: In this cross-sectional study, 143 participants were classified into four groups based on strict diagnostic criteria: healthy controls (HC, n = 44), tinnitus-only (T, n = 49), migraine-only (M, n = 25), and migraine with tinnitus (TM, n = 25). Groups were matched for age, sex, and hearing thresholds. All participants underwent comprehensive audiological assessments, including pure-tone audiometry, ipsilateral and contralateral acoustic reflex threshold (ART) testing to assess MEMR function, and distortion-product otoacoustic emissions (DPOAE) with contralateral suppression evaluation to assess MOCR function.
Results: The migraine group (M) demonstrated significantly elevated contralateral ART (indicating MEMR impairment) at 500 Hz and 1000 Hz (p < 0.001) and globally reduced DPOAE suppression (reflecting MOCR dysfunction) (p < 0.001) compared to healthy controls. The TM group exhibited a similar pattern of MOCR and MEMR dysfunction to the M group, with no significant additive effect from tinnitus comorbidity. A clear gradient of contralateral ART impairment was observed across groups: HC < T < (M ≈ TM). Ipsilateral ART results showed less consistent abnormalities.
Conclusion: Migraine may be associated with specific dysfunction of brainstem auditory efferent pathways, particularly affecting both MOCR and MEMR systems, independent of peripheral hearing status. The convergent abnormalities in migraine patients with and without tinnitus indicate that auditory efferent disruption may be an intrinsic component of migraine pathophysiology. These findings support the potential of contralateral ART as an objective biomarker of migraine-related auditory pathway involvement, highlighting the clinical value of auditory assessment in migraine management and providing insights for the development of targeted therapeutic strategies.
背景：偏头痛是一种常见的神经系统疾病，常伴有耳鸣和听觉亢进等听觉症状。虽然它们的关联提示了共同的神经机制，但关于偏头痛中脑干介导的听觉传出通路的具体参与的客观证据仍然有限。内侧耳蜗反射（MOCR）和中耳肌肉反射（MEMR）是两种重要的听觉保护机制，但它们在偏头痛患者中的完整性仍有待研究。本研究旨在评估MOCR和MEMR通路在伴有和不伴有耳鸣的偏头痛患者中的功能完整性。方法：在这项横断面研究中，143名参与者根据严格的诊断标准分为四组：健康对照组（HC, n = 44）、单纯耳鸣组（T, n = 49）、单纯偏头痛组（M, n = 25）和偏头痛伴耳鸣组（TM, n = 25）。各组根据年龄、性别和听力阈值进行匹配。所有参与者都进行了全面的听力学评估，包括纯音听力学、同侧和对侧声反射阈值（ART）测试以评估MEMR功能，以及扭曲产物耳声发射（DPOAE）和对侧抑制评估以评估MOCR功能。结果：偏头痛组(M)在500 Hz和1000 Hz时显示对侧ART显著升高（表明MEMR损伤）(p)。结论：偏头痛可能与脑干听觉传出通路的特异性功能障碍有关，特别是影响MOCR和MEMR系统，与外周听力状态无关。伴有和不伴有耳鸣的偏头痛患者的会聚性异常表明，听觉传出干扰可能是偏头痛病理生理的内在组成部分。这些发现支持对侧ART作为偏头痛相关听觉通路参与的客观生物标志物的潜力，突出了听觉评估在偏头痛管理中的临床价值，并为开发靶向治疗策略提供了见解。
期刊介绍：
The Journal of Headache and Pain, a peer-reviewed open-access journal published under the BMC brand, a part of Springer Nature, is dedicated to researchers engaged in all facets of headache and related pain syndromes. It encompasses epidemiology, public health, basic science, translational medicine, clinical trials, and real-world data.
With a multidisciplinary approach, The Journal of Headache and Pain addresses headache medicine and related pain syndromes across all medical disciplines. It particularly encourages submissions in clinical, translational, and basic science fields, focusing on pain management, genetics, neurology, and internal medicine. The journal publishes research articles, reviews, letters to the Editor, as well as consensus articles and guidelines, aimed at promoting best practices in managing patients with headaches and related pain.
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