Clinical features of chronic tension-type headache combined with hyperacusis: a cross-sectional study

Abstract

BACKGROUND: Chronic tension-type headache (CTTH) is a prevalent primary headache disorder that significantly affects quality of life. Hyperacusis, an abnormal intolerance to everyday sounds, is frequently observed in patients with CTTH, suggesting potential shared neural mechanisms. However, the clinical characteristics of patients with CTTH and comorbid hyperacusis remain poorly characterized.

OBJECTIVES: This study aimed to investigate the clinical characteristics of CTTH patients with comorbid hyperacusis, focusing on headache profiles, auditory sensitivity patterns, and psychological correlates, and to identify factors independently associated with hyperacusis in this population.

DESIGN AND SETTING: A cross-sectional study was conducted at the outpatient department of the Third Affiliated Hospital of Qiqihar Medical College from January 2022 to December 2024.

METHODS: We consecutively enrolled 234 patients with CTTH diagnosed according to International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria were consecutively enrolled. Hyperacusis was confirmed via otolaryngological evaluation and audiometric testing (pure-tone thresholds and loudness discomfort levels [LDL]). Demographic data, headache features (frequency, intensity, and duration), hyperacusis distress severity, and psychological measures (Generalized Anxiety Disorder-7 [GAD-7], Self-rating Somatic Symptom Scale [SSS], and Pittsburgh Sleep Quality Index [PSQI]) were analyzed. Univariate analyses (Student’s t-test and Chi-squared test) and multivariate logistic regression adjusted for potential confounders were performed to compare patients with (n = 47) and without (n = 187) hyperacusis.

RESULTS: Hyperacusis prevalence was 20.09% (47/234). Compared to non-hyperacusis patients, hyperacusis patients exhibited longer headache duration (13.9 ± 3.15 versus 8.11 ± 2.74 years, P = 0.01), higher weekly headache frequency (7.30 ± 1.99 versus 4.19 ± 1.2, P = 0.005), more pericranial tenderness (95.74% versus 77.54%, P = 0.008), and poorer sleep quality (PSQI: 14.01 ± 1.13 versus 9.17 ± 0.51, P = 0.004). After adjusting for age, sex, headache duration, and pain intensity in multivariate logistic regression, higher headache frequency (odds ratio [OR] = 1.42, 95% confidence interval [CI]: 1.12–1.79, P = 0.003) and higher PSQI scores (odds ratios = 1.38, 95% CI: 1.15–1.66, P = 0.001) remained independently associated with hyperacusis. Common triggering sounds included children crying (61.7%) and traffic noise (42.55%), with predominant emotional responses being irritability (76.6%) and anxiety (65.96%). LDL classification (analyzed as an ordinal variable) was correlated with headache duration (P < 0.05), while hyperacusis distress severity was linked to headache frequency and PSQI scores (P < 0.05).

CONCLUSION: CTTH with hyperacusis represents a distinct subgroup characterized by a history of prolonged headaches, increased attack frequency, and significant sleep disturbances. The independent associations identified suggest that sound sensitivity is closely linked to headache burden and sleep quality; however, causal relationships require longitudinal investigation. Integrated management addressing both headache and auditory hypersensitivity is warranted.