# Expanding the Spectrum of Central Sensitivity Syndrome: Integrating Otologic Migraine as Otologic Central Sensitivity Syndrome

## TL;DR

The paper argues that non-headache migraine symptoms like tinnitus and vertigo should be classified as otologic central sensitivity syndrome, offering a new framework for understanding and treating these conditions.

## Contribution

The paper introduces the concept of otologic central sensitivity syndrome to unify non-headache migraine symptoms under a central sensitization framework.

## Key findings

- Non-headache migraine symptoms share core features of central sensitization.
- Reframing these symptoms as otologic CSS aligns clinical observations with neuroimaging evidence.
- Adopting the CSS framework may improve diagnosis and treatment strategies.

## Abstract

What are the main findings?
Non-headache migraine manifestations—including tinnitus, hyperacusis, vertigo, dizziness, sudden hearing loss, and aural fullness—share core neurobiological features of central sensitization and are best conceptualized within a unified framework termed otologic central sensitivity syndrome (CSS).Reframing these otologic symptoms under the CSS paradigm provides a coherent explanation for their overlap, chronicity, and comorbidities, aligning clinical observations with neuroimaging and mechanistic evidence of central nervous system hyperexcitability.

Non-headache migraine manifestations—including tinnitus, hyperacusis, vertigo, dizziness, sudden hearing loss, and aural fullness—share core neurobiological features of central sensitization and are best conceptualized within a unified framework termed otologic central sensitivity syndrome (CSS).

Reframing these otologic symptoms under the CSS paradigm provides a coherent explanation for their overlap, chronicity, and comorbidities, aligning clinical observations with neuroimaging and mechanistic evidence of central nervous system hyperexcitability.

What are the implications of the main findings?
Adopting the otologic CSS framework may enable earlier recognition, reduce misdiagnosis and stigma (particularly when headache is absent), and support more targeted, mechanism-based management strategies.This conceptual shift encourages clinicians to move beyond headache-centric migraine definitions, validating otologic symptoms as centrally mediated and promoting more comprehensive, multidisciplinary care that can improve patient outcomes and quality of life.

Adopting the otologic CSS framework may enable earlier recognition, reduce misdiagnosis and stigma (particularly when headache is absent), and support more targeted, mechanism-based management strategies.

This conceptual shift encourages clinicians to move beyond headache-centric migraine definitions, validating otologic symptoms as centrally mediated and promoting more comprehensive, multidisciplinary care that can improve patient outcomes and quality of life.

Objective: To propose that migraine-related symptoms such as dizziness, sudden hearing loss, tinnitus, and vertigo—when occurring without headache—should be recognized as manifestations of central sensitivity syndrome (CSS), and to explore the implications of this reclassification for clinical practice and patient care. Data sources: PubMed Central and Google Scholar. Review methods: A search of the literature was performed using PubMed and Google Scholar. Search terms included combinations of keywords such as “migraine”, “vertigo”, “tinnitus”, “dizziness”, “sudden hearing loss”, “central sensitivity syndrome”, and “central sensitization”. Conclusions: Non-headache migraine symptoms show significant overlap with characteristics of CSS, including central nervous system hyperexcitability and dysregulation. Neuroimaging and clinical data support this connection, suggesting these symptoms may be better understood within the CSS framework. Recognizing this association could represent a conceptual shift in how such symptoms are classified and managed. Implications for practice: Incorporating non-headache migraine symptoms into the CSS paradigm may lead to earlier recognition, reduce misdiagnosis and stigma, and support the development of more effective, targeted therapeutic strategies for affected patients.