Migraine Drugs and Tinnitus

by Neil Bauman, Ph.D.

A man explained,

I have been prescribed the following drugs for migraine with aura. As I already have tinnitus I’d like your opinion on the following drugs as regards tinnitus, sound sensitivity and hearing loss.

1) Divalproex/Valproate 2) Flunarizine 3) Migranex 4) In cases of acute headache, the following are to be taken as soon as possible—Naramex and Naxdom.

From my search of the literature, Flunarizine seems to be the best bet as far as not making my tinnitus worse. What do you think?

I consider Divalproex (Depakote) a very ototoxic drug—a Class 4 out of 5 in my rating system. It has a number of ototoxic side effects that occur in quite a high percentage of the people taking it such as hearing loss, tinnitus, ataxia, dizziness, nystagmus, vertigo, ear pain, etc. This would be my last choice if all else failed.

Valproate (Depacon) is also a Class 4 drug in my opinion and can cause much the same ototoxic side effects and at much the same incidence levels as Depakote. Again, this is a good drug to avoid except as a last resort.

Flunarizine (Flunarin) is only mildly ototoxic. Some people may get dizziness/vertigo from taking it. This drug would be my second choice.

I’m not sure which Migranex you are referring to. There are different ones with different formulations. For example:

MigranEx by Adeeva is a herbal. It is basically composed of the herbals Butterbur and Feverfew. Neither of these are known to be ototoxic—so if this works, it would be my first choice (of the list you sent).

Migranex by Hexal Pharmaceuticals is composed of caffeine, dehydrocholic acid, gelsemium, magnesium citrate, phenazone and St. John’s Wort. As far as I know, only the caffeine in this formulation is mildly ototoxic. Caffeine can cause tinnitus, dizziness and vertigo if you get too much of it.

There may be other Migranex products with different formulations, so you have to read the labels carefully.

I can’t find any listing of Naramex so can’t help you there.

Naxdom contains the drugs Domperidone and Naproxen. Domperidone is only mildly ototoxic and can cause dizziness and loss of balance in some people. However, Naproxen is quite ototoxic (Class 4 out of 5) and can hearing loss, tinnitus, dizziness, vertigo, etc. in numbers of people. It would be my 2nd last choice—just before Divalproex and Valproate.

You are right about Flunarizine. Of the above drugs it definitely seems to be the least ototoxic, but if I were you, I’d definitely try the herbals before I’d try the drugs.

If you want to look up for yourself the side effects and degree of ototoxicity of various drugs, see my book “Ototoxic Drugs Exposed” 3rd edition. This book contains information on the ototoxicity of 877 drugs, 35 herbs and 148 chemicals.