Dietary Triggers as Clinical Indicators of Migraine-Associated Tinnitus: A Case Series

Background: Tinnitus is the perception of sound in the absence of external auditory stimuli. Management usually involves education and cognitive behavioural therapy. However, in cases where there is an underlying medical cause, such as migraine, targeted treatment may lead to subjective improvement. Migraine is a complex neurological disorder characterised by a wide range of symptoms beyond headache alone, including tinnitus exacerbations. Patients presenting with fluctuating tinnitus and hearing loss after dietary triggers may represent an atypical migraine phenotype. Diagnosis requires an in-depth clinical history and may not always meet strict thresholds of International Classification of Headache Disorders criteria. Methods: Objective is to present a case series of tinnitus precipitated by dietary triggers, guiding diagnosis and management. Case series of three patients aged 43 to 72 presenting to Audiovestibular Medicine clinic with fluctuating tinnitus, hearing loss and vestibular symptoms, triggered by specific dietary factors. Outcome measured by symptomatic improvement following trigger avoidance and tailored migraine management. Results: Dietary triggers included dark chocolate, coffee, seafood, strawberries and chilli. Neuroimaging and vestibular testing were unremarkable. Mechanisms likely to be involved include trigeminal neurovascular sensitisation and cortical spreading depression. Management involved dietary trigger avoidance, lifestyle modifications, stress reduction, hearing therapy, vestibular rehabilitation, and pharmacological prophylaxis following UK National Institute for Health and Care Excellence guidelines. Significant symptomatic improvement was achieved in all cases. Conclusion: Dietary triggers can unmask an underlying migrainous disorder presenting primarily with auditory and vestibular symptoms. Recognition of these triggers, combined with detailed clinical history, is crucial for early diagnosis and effective management. Lifestyle and dietary adjustments alongside targeted migraine prophylaxis significantly reduce tinnitus exacerbations. Awareness of atypical migraine presentations in the management of tinnitus is essential.