Doctor Prescribes Headache Medicine That May Impact Tinnitus

Hi Dr. Nagler:

First, even as a newbie to the forum, it's clear that you've spent a lot of time here helping those in need. Thanks.

Yes, of course, I realize that I'm not your patient and that you've not examined me, so if I'm asking something you can't fairly answer, I understand if you can't answer with specifics. In that case, I'll take whatever generalities I can get from you!

BRIEF HISTORY:

While my tinnitus started in 2006 (along with some bilateral hearing loss), it has gotten ferocious over the past three months or so and my hearing also took another big hit. I'm demoing some hearing aids, but it's complicated b/c I'm much more sensitive to environmental sounds than ever before now. The habituation I fought for tooth and nail for a few years is out the window these days and it's like I never had tinnitus until now. Along with the increased tinnitus, I've had headaches non-stop for about the past three months (along with some jaw pain, some nausea/vomiting, neck pain.) Brain/ear canal MRI = negative.

QUESTION 1:

My ENT, in hopes of improving circulation to the ear and doing "something" to forestall further hearing loss and even more malicious tinnitus (not specifically to reduce tinnitus), prescribed pentoxifylline ER 400 mg once/day. It was my understanding that while Rx wasn't likely to reduce the tinnitus it wouldn't increase or add to it either.

I took one dose a few days ago and about 4.5 hours later (while in bed) the noises increased significantly for no other apparent reason.

I told my ENT that I planned to stop the Rx and she indicated that I should reconsider, noting that pentoxifylline has no history of causing tinnitus or aggravating an existing case of tinnitus, except that in a very small number of cases the change in cell function caused by increased flow of blood/oxygen/nutrients can result in a temporary perception of increased loudness at the beginning of treatment while the cells reach a new, heightened level of metabolism. In that small group of cases, the perception of louder tinnitus will spontaneously resolve after a few days once the cells settle into their new level of homeostasis.

I guess my question is, does the ENT's description hold water and should I start taking the pentoxifylline again? Is the potential benefit worth the potential cost?

QUESTION 2:

As I noted, I've been having headaches every day of varying levels of severity since the tinnitus kicked up to crazy levels about 3 months ago. My primary referred me to a neurologist, who after taking a history and examining me tells me I have something called New Daily Persistent Headache http://www.medscape.com/viewarticle/723842_5).

The first thing he wants to do treatment-wise (after sending me for a MR venography to rule out cerebral venous sinus thrombosis) is put me on a low dose of nortriptyline (he said 20 mg but I requested to start at 10 mg and he said OK).

I'd have enough of a problem deciding whether to take a tricyclic antidepressant for headaches even if I didn't have tinnitus, but with the existing tinnitus I just don't know what to do. I know that nortriptyline seems to have reduced tinnitus in some and increased it in others.

I realize that the final decision re: whether to take the nortriptyline for headaches is mine, of course, but I'd welcome any expert counsel you might have for me in making that decision.

Many thanks.




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I am unaware of any studies wherein pentoxifylline was found to have any positive impact on tinnitus or in the course of the condition. That said, the drug does not cause any auditory damage so there should be no concern in that regard. In one study the incidence of developing tinnitus while on pentoxifylline was 0.24%. Such tinnitus should be expected to be reversible upon discontinuing the drug. If it does not resolve, then the problem was not the pentoxifylline in the first place.

If your doctor recommends a trial of nortriplyline for your headaches, I would go ahead with it. As with pentoxifylline, in the unlikely event that your tinnitus increases, it should return to baseline within 10-14 days after discontinuing the drug.

Hope this helps.

stephen nagler