Migraine and sound sensitivity

Sound sensitivity is part of migraine

If noise feels unbearable during a migraine attack, you are far from alone. The NHS lists being very sensitive to light and sounds as one of the main symptoms of an attack, alongside a throbbing headache and feeling or being sick.

Doctors call this phonophobia. In the international headache classification (ICHD-3), it means hypersensitivity to sound, even at normal levels, that usually makes you avoid it. It is part of the formal criteria for migraine: during the headache, a person needs either nausea or vomiting, or sensitivity to both light and sound.

How common is it?

Very common. In a large US survey of more than 6,000 adults with migraine, 92.5% said sound sensitivity came with their headaches at least some of the time. About 1 in 5 (22.8%) named it as their most bothersome symptom, after sensitivity to light and nausea.

It is not limited to the headache itself. The Migraine Trust describes sensitivity to light, sound or smell in the early warning stage (the prodrome), during the headache, and sometimes in the recovery stage afterwards. In one study of 1,010 people at a headache centre, sound sensitivity was among the most frequent early symptoms. The authors suggest that some “triggers” people notice, such as noise, may actually be early signs of an attack that has already started.

Between attacks

Some research suggests the brain stays a little more sensitive to sound even between attacks. A small controlled study measured the lowest volume at which tones felt unpleasant or painful. People with migraine had a lower threshold than people without migraine between attacks, and a lower one still during an attack. This was a study of 60 people with migraine, so it points to a pattern rather than a rule.

How is it different from hyperacusis?

The NHS describes hyperacusis as everyday sounds seeming much louder than they should, and it lists migraine as one of the conditions it can appear alongside. The two can feel similar in the moment, but they tend to behave differently over time.

One source of confusion is the word itself. Headache doctors use “phonophobia” for sound sensitivity during an attack, while the NHS hyperacusis page uses it for sounds that make you anxious. Our guide to phonophobia explains both meanings.

If sound stays hard to tolerate on days without migraine, it is worth mentioning to your GP. The NHS says that when hyperacusis is caused by another condition, such as migraine, treating that condition may help. Read more about how hyperacusis is diagnosed.

What can help during an attack

• Rest somewhere dark and quiet. The NHS suggests sleeping or lying down in a darkened room during an attack.
• Take your medicine early. Painkillers work best taken as soon as the headache starts, according to the NHS and The Migraine Trust.
• Use ear protection for short spells only. For hyperacusis, the NHS says short-term use of earplugs can help in very noisy places, but wearing them all the time may make you more sensitive. See our guide to earplugs and hyperacusis.
• Keep a diary. Noting what happened before each attack can help you and your GP spot patterns.

Treating migraine with your doctor

Migraine cannot be cured, but the NHS says treatment can ease attacks and help prevent them. For attacks, options include painkillers such as ibuprofen and paracetamol, medicines called triptans and gepants, and anti-sickness medicines. To prevent attacks, a GP may suggest preventive medicines, acupuncture, relaxation techniques, cognitive behavioural therapy (CBT) or vitamin B2, along with regular meals, sleep and less caffeine.

Watch your painkiller days. The NHS advises trying not to take painkillers for more than 2 days a week, as this can cause more headaches and make migraine harder to treat.

See a GP if your attacks are severe, getting worse or lasting longer than usual, if you have them more than once a week, or if they are hard to control.

When to get urgent help

Ask for an urgent GP appointment or contact NHS 111 if a migraine attack has lasted longer than 72 hours, aura lasts longer than an hour, or you are pregnant or have just had a baby.

Call 999 or go to A&E if you have a headache and:

• it came on suddenly and is extremely painful
• you have had a seizure (fit)
• you have numbness or weakness in the body or face
• you find it hard to speak, balance, walk or remember things
• you are drowsy or confused, or have lost your vision
• you have had a head injury within the last 3 months
• you have a very high temperature, a stiff neck, or a rash that does not fade when a glass is rolled over it

Do not drive yourself to A&E. For more on noise sensitivity that lasts beyond attacks, see hyperacusis treatment and living with hyperacusis.