Long Time Lurker, First Time Posting: Tinnitus from Almotriptan?

Hi everyone! My name is Sarah, and I have tinnitus (sounds a bit like AA!). It started last November following an unprecedented three day migraine. I had been doing well using magnesium the month prior for my migraines and was feeling so good I decided to get a massage. I hadn't had one in a while as it usually induces a migraine - my migraines are very much correlated with neck/shoulder/back muscle tension. I have been taking acute migraine medicine (almotriptan) for the past 1.5 years and had recently been using an over-the-counter muscle relaxant with ibuprofen to take the edge off - all under my doctors supervision.

After recovering from my three day migraine, I decided to see a Naturopath, to find the best, natural way to manage the migraine/muscle pain (in the past five years or so I have seen Chiropractors, Physios, RMT, Osteopath, etc. which only provided temporary relief). I have been experiencing migraines for the last 10-15 years, progressively getting worse in the last two years. She set me on a course of supplements including magnesium, B complex, Q10, probiotics, vitamin D, etc. Everything was going well, until mid-November I began experiencing extreme intermittent dizziness and tinnitus. It was awful! The dizziness was the worst as I felt like I couldn't do anything. This lasted until just before Christmas, when I was finally diagnosed by the doctor with 'fluid behind the eardrum'. I had to go to a clinic and saw a different doctor each time, as my doctor had retired in September (I was going to the clinic at least 1-2 times per week) prior to finally being diagnosed. Following that, I was inhaling Flonase and trying to unclog my ears (ears feel clogged, particularly first thing in the morning - mostly right ear) until early February, when I finally was able to see the ENT. Hearing test normal (up to 8kHz), he did a quick check of my ears (said my ears were perfect! LOL), etc. and dismissed me as having TMJ, even though I had no jaw pain. I had a nightguard made by my regular dentist (who knows nothing about TMJ) and made an appointment with a dentist who specializes in TMJ. He didn't see any indications of TMJ so I ditched the nightguard.

I did some more research and found out about upper cervical chiropractic care and quickly booked myself in for an assessment (known to help with migraines, muscle pain, tinnitus). I have been receiving treatment for the past two months and am seeing some relief from my migraines, although it has been painful as my muscles are still adjusting/healing. No relief yet from my tinnitus yet. It has a weird pattern of one day loud, one day quieter, and next day nothing (unless I really listen for it in a quiet room). I have recently been having 1.5 to 2 days of quiet, which didn't happen before (except Christmas where I had two days off, one day on, and three days off - that was a nice gift!). I've only had a handful of days where it's changed mid-day (starts off in the morning quietly and then disappears around noon or starts off quiet and then ramps up around 3pm - it's on some sort of schedule!), otherwise, it's the same all day, until I wake up the next morning. Sleep hasn't been much of an issue, thankfully. I'm just guessing about the loudness (maybe 5-6/10 at it's worst), but there is some low level sound sensitivity to sharp noises (dishing banging together, etc.) and TV sounds seem to exacerbate it a bit.

I'm hitting the six month mark and am not sure what to do next. I was supposed to have a follow up with the ENT late March, but that got cancelled due to COVID and of course, he didn't call me like he was supposed to. I don't think I'll get anywhere with that anyway! I'm scheduled to see an audiologist once they are able to open up. I saw a neurologist just before Christmas and I passed her physical. She told me that I was taking too many almotriptan, but of course offered no suggestion on how to deal with my pain/migraines. She scheduled me for an MRI in March, but that has been postponed to June - I'm not sure that I will go, I'm afraid the noise may make my situation worse. The neurologist suggested that since I'm having success with reducing my migraines, she doesn't deem it necessary, but another doctor is pushing me to have it because of the tinnitus. As well, I have been experiencing some pain in my right ear predominantly for the past few months, more like a low level ache a few times a week (this wasn't an issue when I first exhibited symptoms) and ache in my right jaw and neck. Sometimes I feel a fleeing pain in my left ear. I wonder if my tinnitus is due to the medication, and I kept taking it (stopped the ibuprofen two months ago, however, I need the migraine medicine) wouldn't my tinnitus be worse? Dizziness has mostly subsided (only occasionally do I feel it).

Anyway, sorry for the long-winded post, but I thought I might as well just tell my story in one go and see if anyone has had similar symptoms/experience/advice. I haven't completely broken down yet, although I did have a nice cry the other day while I was walking and talking to myself (and God).

Nice to finally meet everyone!

 

HI @LilSass

Welcome to the forum. Since you have had tinnitus for quite a while and been a visitor to this forum. You probably know there are three possibly four things that cause tinnitus although it can also appear for no reason.

The most common is exposure to loud noise. Typically it is listening to music or other types of audio through headphones, earbuds or a headset at too high a volume and for long durations. An underlying medical problem within the auditory system can cause it too, so it's good that you have an appointment to be seen at ENT. Some medications can cause it. A condition called TMJ that is associated with the jaw joint. Tinnitus can also be caused by stress. Pulsatile tinnitus is another condition, although not the same as ordinary tinnitus it can be just as troublesome. It relates to changes in the flow of blood in the vessels of the neck and ear and makes a rhythmical noise usually at the same rate as a heartbeat.

I am familiar with noise induced tinnitus. If your tinnitus is caused by this I might be able to help you further.

All the best
Michael

 

Hi Michael! Thanks for the quick response. I have read quite a lot of your postings - glad to finally meet you. I'm fairly confident that it isn't noise induced, but one never knows. I was using ear buds a few times a week for around 15 minutes per day, at a reasonable volume (IMO) and there was never any indication of tinnitus or any ear damage previous. Never went to many concerts nor spend a lot of time in noisy places. Possibly it may have something to do with the massage (somatic), although I cannot modulate it, so seems doubtful. I would liken the sound to crickets, tone doesn't change, just volume, so doesn't sound like pulsatile. Of course, all of the doctors I talk to don't seem to think it's from the medication, but then again, they seem to know very little on the subject!

 

HI @LilSass

Since you have been a visitor to this forum for a while, I had a feeling that you might have come across some of my posts, and for this reason didn't paste any links to them. If your tinnitus was noise induced you would know by now so perhaps it isn't. I can only suggest that you use low level sound enrichment whenever possible and especially at night, although you probably do this already.

It is nice to meet you too and I hope you are able to get some help when you're seen at ENT.

Take care
Michael

 

This is hyperacusis. Normally it goes away after a year or two.

In that case, you might want to either find the volume setting that doesn't cause the above or to stop watching TV until you are over this symptom.

Have you experienced any improvement compared to how it was three months ago?

Only have an MRI scan if you are sure that your health will deteriorate without one. There is certainly a risk of getting a Permanent tinnitus spike following an MRI (I know at least two people it happened to). I have no idea how high the probability of it happening, though, but it is certainly not unheard of...

You might want to get an second opinion regarding TMJ.

Search for all of your medications using the search function of this forum. Sometimes you find a large number of horror stories, even for drugs that don't appear on any ototoxic drug lists.

 

Hi Bill,

Thanks for your response and support. I have two very naughty kitties of my own! Luckily the hyperacusis isn't too bad, and from what I've read, I shouldn't protect me ears too much. I haven't had any spikes from this nor anything else (coffee, salt, sounds, etc.) - it just follows the same pattern. I have always been careful with my hearing (in regards to noise), or so I thought!

The TV is kept at a low volume and only affects me when I'm having a loud day - if it is relatively quiet or almost non-existent this isn't really an issue. Unfortunately right now it is one of the only things that is making me feel sane! Definitely no ear buds, headphones, etc.

The improvement has been that I have been experiencing more two days of a row of quiet. Hopefully this continues and the volume goes down a bit. My mother-in-law developed t five years ago from prednisone (her doctor had her on it for over two months!) and she said it took almost two years and she now only has it a few times a week for a few hours at a time (she was having it daily at the beginning) - I'm hopeful mine will improve.

I will probably wait on the MRI, possibly get a CT scan instead. I'm just not willing to risk it right now, and as my migraines are improving with my current chiro and physio treatment, I see no reason to rush into anything until I'm comfortable.

My chiro thinks that the ear/jaw/neck pain may be due to the SCM being tight. I had a 2.5 degree subluxation of my atlas vertebrae which was throwing my muscles way off and causing a lot of pain/migraines. The adjustment to realign my skull with my spine should correct any TMJ issues (I'm not sure how much you know about upper cervical chiro, but it can help a whole slew of issues). It takes 3-6 months for muscles to heal.

I have thrown out all medicine that are ototoxic, except my migraine medicine (I believe it was the combination of almotriptan with ibuprofen that was the root cause) - for now I need it and unfortunately there aren't any alternatives that are any better.

I'm not sure about 'sound enrichment' at night - I've been able to sleep without it. I read that white noise can have a negative effect on the brain. Any advice from you and or Michael on that issue would be greatly appreciated.

My only other issue is the feelings of imbalance - the ENT didn't seem to be too interested. I can have that looked into with the audiologist as she also specializes in vestibular issues. It's only occasional now and noting as bad as it was before - I admit some of that is probably related to feelings of anxiety.

Again, thank you so much for your invaluable insight! It's good to know that there are others out there willing to help.

Sarah

 

I am sorry to hear about your challenges. The balance issues intrigue me since my severe hyperacusis began as major balance problems with mild hyperacusis and evolved into life-altering hyperacusis with the balance problems completely gone. I actually don't think most people's tinnitus story begins with balance problems -- it's typically noise trauma to the hair cells or synapses.

I just started taking magnesium, B12, and vitamin D as well.

I would be very careful about an MRI. If you do decide to do it, whatever you do, do not get an MRI without protection. Also, I would only do it if there is a specific purpose and the doctor has convincing reasons (i.e. legit fear of a tumor, etc.).

 

Thanks for your concern Zugzug! As it stands, I won't be getting the MRI. I still have some research to do, but even with ear protection, I'm just not comfortable with it and don't think it's necessary at this time. I'm doing some yoga to deal with the balance issues since I can't see a vestibular specialist right now. Magnesium is great for your muscles i.e. relaxation and sleeping. Yeah, pretty sure it's not noise induced, not 100% positive about the medication either, but it seems the most likely culprit. It confuses me that my symptoms haven't worsened (in fact the balance issue has gotten better) since the initial onset (mid-November to mid-December) yet I was taking the same medication in the same doses until about two months ago (when I finally realized how ototoxic ibuprofen can be). Seems there aren't always logical explanations when it comes to this condition.

I hope you're keeping well! Sometimes all we can do is take one day at a time.

 

A strange pattern in my problem is that I started off with debilitating balance problems. I started exercising because I read about retraining the brain to compensate and what ended up happening was my balance problems resolved, but the exercise kept making my hyperacusis and tinnitus worse. I've learned that I'm not allowed to have nice things. If something helps me, there is a mistake somewhere.

 

Yeah, it's amazing that you can do all the 'right' things and still get screwed (I tried all the natural remedies, but they were only band aid fixes)! I really thought that I'd be able to resolve my migraine issue, but it seems that I've traded one issue for another. I'm managing my migraines better, but who knows, I'm not out of the woods yet. Kinda of kicking myself as I had some inkling about ototoxic drugs, but when you're in so much pain all you want to do is be out of pain. I've always been sympathetic to others plights, but I never really realized how many people are in so much pain (physical and mental)...makes it hard to believe in any kind of merciful God (still on the fence about that one - I say I don't really believe but then I end up talking to him/her!).

Have you heard of upper cervical chiropractors? If you have, I won't waste your time. It's not a cure all but might be worth a try. This website explains it well. https://www.riosspinalcare.ca/nucca/

Take care!

 

I am convinced that my tinnitus began improving only once I began being serious about protecting my ears from even the moderate sounds (e.g., the sound of a vacuum cleaner, blender, lawn mower). It is certainly possible to overprotect, but you would need to be wearing muffs 24/7 for that. Otherwise it is safer to err on the side of overprotecting compared to erring on the side of underprotecting.

A number of people on this forum described similar symptoms. My tinnitus isn't like that, so I confess that I haven't paid enough attention to those posts. You might want to locate those posters and track down what happened to their tinnitus.

Awesome! Hopefully you will have a similar experience.

Ibuprofen is ototoxic. Tylenol is the least ototoxic pain killer...

Different people have different experiences. Try it. If you get a spike, it will very likely be temporary and you can always quit.

 

Thanks Bill! I appreciate your concern and advice.

I have some earplugs that I use when I go out, mostly because my right ear can get a bit achy when it's cold and/or windy. Unfortunately, they are not good for noise reduction. I will be ordering some from Amazon this week, are there particular ones you recommend? I haven't noticed that anything 'spikes' my t - if a noise/food affected it, would I notice it right away, a few hours after, or the next day? It just seems to follow the same pattern regardless.

I did try Tylenol maybe a month or so ago to take the edge off my migraine (two hours after taking acute migraine medicine) and noticed that about 1/2 hour later t started up (previously unnoticeable), so I will be staying off of it. Funnily enough, nothing changed over months of taking the same dose/frequency of almotriptan and ibuprofen (it didn't get worse), but since I stopped taking ibuprofen about two months ago, I am having more two days of quiet.

Again, no 'spike' with white noise, although I have only used it a few times (when sleeping). The one time I used it for a couple of nights and had two days of loud t (can't really say if it's correlated). I am sleeping fine without it - I'm just not sure what the benefits are.

Thanks again! Hope you're able to enjoy the beautiful weather we're having today (not sure if you're in Ontario).