Auditory brainstem function in migraine with aura and without aura: a comparative study

Abstract Background Migraine involves complex neurovascular mechanisms with evidence of brainstem dysfunction, particularly in auditory processing. Comparative data between migraine with aura (MA) and without aura (MoA) using detailed electrophysiological and psychoacoustic assessments are limited. In this study, we aim to compare auditory brainstem function in MA and MoA patients and healthy controls and assess correlations with migraine characteristics. Methods Forty-one migraine patients (18 MA, 23 MoA) and 41 matched controls with normal peripheral hearing underwent clinical evaluation, Arabic Central Auditory Processing Disorder (CAPD) questionnaire, basic audiologic testing, masking level difference (MLD) at 500 Hz and 1000 Hz, and auditory brainstem responses (ABR) at low and high repetition rates. ABR parameters included absolute latencies (Waves I, III, V), interpeak intervals, and V/I amplitude ratios. Results Basic audiologic measures Pure-Tone Average (PTA), Speech Reception Threshold (SRT), Word Discrimination (WD) were normal in all participants. Migraineurs showed significantly higher MLD scores than controls (MLD 500: 9.3 ± 1.7 vs. 4.5 ± 1.4 dB; MLD 1000: 9.5 ± 1.7 vs. 4.6 ± 1.2 dB; p < 0.001). ABR revealed prolonged latencies (LIII, LV, HI–V) and interpeak intervals (LIII–V, LI–V) in migraine ( p < 0.001), indicating central auditory brainstem dysfunction. Compared to MoA, MA patients had longer LV ( p = 0.041) and greater interaural amplitude asymmetry (LHV1a, p = 0.035). In MA, ABR latencies correlated strongly with attack frequency and disability by using Migraine Disability Assessment (MIDAS) ( r = 0.78–0.84, p < 0.01). Conclusion Both MA and MoA present with central auditory brainstem abnormalities despite normal peripheral hearing. MA shows subtle but significant prolongations in brainstem conduction and asymmetry, which correlate with clinical severity. These findings address a gap in migraine research by providing subtype-specific electrophysiological evidence, supporting the potential use of ABR parameters particularly latency of wave III, V, IV and interpeak interval I–V as objective biomarkers for disease monitoring and targeted intervention.