(811) Association of Headache and Migraine in Patients With Patulous Eustachian Tube

Introduction: This study evaluated the incidence of headache and migraine among patients with patulous eustachian tube (PET) compared with matched healthy controls and characterized clinical features associated with migraine in PET.

Methods: A retrospective cohort study was conducted using the TriNetX research network. After propensity score matching, 3,392 patients with PET were compared with 3,392 controls without otologic disease or prior ear surgery. Outcomes included incident diagnoses of headache, migraine, migraine without aura, and migraine with aura. A secondary analysis compared PET patients with and without comorbid migraine to evaluate differences in otologic, vestibular, and neuropsychiatric diagnoses.

Results: PET patients had a higher incidence of headache than controls (risk ratio [RR] = 1.274, 95% CI: 1.092-1.486; p=0.002) and migraine (RR=1.196, CI: 1.028-1.392; p=0.02). The composite outcome of headache or migraine was also more frequent in PET patients (RR=1.225, CI: 1.092-1.374; p=0.0005). Among migraine subtypes, migraine without aura occurred more commonly in the PET cohort (RR=1.620, CI: 1.21-2.169; p=0.001), whereas migraine with aura did not differ significantly (RR=1.241, CI: 0.926-1.662; p=0.15). In secondary analyses, PET patients with comorbid migraine showed increased rates of dizziness, benign paroxysmal vertigo, otalgia, and anxiety, whereas rates of tinnitus and hyperacusis did not differ significantly.

Conclusions: PET is associated with increased incidence of headache and migraine, particularly migraine without aura. Among PET patients, comorbid migraine is associated with greater vestibular, otologic, and anxiety symptom burden, underscoring clinical heterogeneity within PET. The link between PET and migraine may be due to sustained increased trigeminal nerve output in migraine patients, leading to increased tone in the tensor veli palatini muscle.