@bluey
I also developed first tonal T and, after a while, PT.
What's important is that, from my experience, PT is settling, is becoming less intense. I do not remember how long it took PT to become less often and intense in my case, cause I have not kept a diary, but I am sure that it was much more than a year.
In Karen's case, it took 5 years.
After five years of pulsatile tinnitus I think mine is becoming less intense,
So don't be discouraged. Chances are that PT will will lessen in time, and not get worse.
I personally recommend swimming, for improving blood circulation, for making it "even" (sort of)
We were trying to come with an explanation as to why people with tonal T get PT also after a while. Is it possible that the PT that follows is not from another vascular problem that occurred on top of the health problem that produced the tonal T initially, but maybe just the ear, the same way it becomes hypersensitive versus the outside sounds, condition named "hyperacusis", it becomes hypersensitive to the inner sounds, which is the pulse, in our case the pulse of the carotid artery, as
@glynis says.
However, let me caution that people with intense PT should seek out the advice of a doctor, just to rule out any serious or fixable conditions.
Of course, Karen, that I "let you caution people to be tested to rule out a serious condition".
(In a parenthesis, let me tell you that I got tested vascularwise with a angiography which, if I may add, was the most difficult test I went through, because it was done without being put to sleep, and I was awake the whole time and felt everything, including the moments when that contrast solution entered my eyeball's blood vessels, and I felt like it was going to blow up. Very nasty test, when done being awake.
The result of the test was that I had intracranial hypertension, which gives PT, but, unfortunately, I wasn't given a lumber puncture to take some CSF out, nor I was prescribed meds that decrease the production of CSF (cerebrospinal fluid). The problem is that intracranial hypertension can put pressure on the optical nerve and, I must say, since then my vision got worse and worse, at a dramatic speed. Eventually, intracranial hypertension can lead to blindness.
The diagnosis of intracranial hypertension wasn't confirmed again later on by a CT test, so I wasn't given any treatment for it. But that is just my case, told in a parenthesis. I think that I may have developed intracranial hypertension because after tonal T onset I couldn't sleep anymore, in the morning I was more tired than in the evening, I got teribly exhausted, drained of energy, so I became bedridden, incapable of normal functioning, let alone exercising, so I started to put on weight, probably a lot in a short time, which is a cause of developing intracranial hypertension. But that doesn't mean that you guys developed the same problem)
You may try the effect of a diuretic, which lowers the blood pressure and the pressure of the cerebrospinal fluid. You may have the surprise that the diuretic helps improving the PT.
So go to a doctor to get checked with whatever tests he considers relevant, try a diuretic, and take heart, in time chances are that the PT will improve.
Good luck!