All patients who reported the existence of headaches in the TSCHQ ( n = 489) were contacted by mail and asked to complete additional questionnaires ( 16). The analysis was based on datasets of all patients, who presented at the multidisciplinary Tinnitus Center of the University of Regensburg between 20 and whose data were included in the Tinnitus Research Initiative database ( 19) ( n = 1,817). In detail, we investigated whether tinnitus patients with specific forms or laterality of headache differ in demographic or other clinical characteristics from those tinnitus patients without headaches. Patients who reported the existence of headaches in the Tinnitus Sample Case History Questionnaire (TSCHQ) ( 17) and who completed an additional headache questionnaire ( 18) were compared in their clinical and demographic characteristics with those patients who had tinnitus without headaches. In order to investigate comorbid headache as potential criterion for tinnitus subtyping, we retrospectively analyzed clinical data from patients who presented at the multidisciplinary Tinnitus Center at the University of Regensburg. Based on this reasoning, one may assume that headache as a comorbidity may represent a relevant factor for subtyping of tinnitus. Since unilateral headaches and unilateral tinnitus symptoms occur in the majority of cases on the same side and headache and tinnitus are interacting over time, alterations in the trigeminal nerve activity have been proposed as a potentially relevant overlapping pathophysiological factor ( 16). Particularly frequent among tinnitus patients are unilateral headache syndromes ( 16). These studies indicate that between 26 and 47% of patients with tinnitus also suffer from headache. In the previous studies, an association between tinnitus and headaches has been demonstrated ( 14– 16). Tinnitus-related health burden can be measured by specific validated tinnitus questionnaires (TQs) like the TQ ( 11) or the tinnitus handicap inventory ( 12), but also by numeric rating scales ( 13). Moreover, comorbidities such as hyperacousis ( 3), hearing loss ( 5), insomnia ( 6, 7), depression ( 8, 9), and pain syndromes ( 10) play a major role for tinnitus-related impairment in quality of life. As an example patients with tinnitus and comorbid TMJ disorders were younger, more frequently female and suffered from less hearing loss ( 4), indicating that this group represents a clinically relevant tinnitus subtype. Specific comorbidities such as hyperacusis ( 3) or temporomandibular joint (TMJ) disorders ( 4) have turned out to represent potentially relevant criteria for subtyping. The identification of relevant criteria for subtyping different forms represents a major challenge in tinnitus research ( 1, 2). Accordingly, it has been assumed that there exist many different forms of tinnitus that also may differ in their pathophysiology. non-pulsatile), its laterality (unilateral, bilateral, in the head), its maskability, its etiology, and its comorbidities. Subjective tinnitus can vary in its perceptual characteristics (loudness, pitch, number of tones, tonal or noise-like, pulsatile vs. In contrast, in subjective tinnitus, there exist neither external nor internal sound sources. These forms are defined as objective tinnitus. In some forms of tinnitus, there is an internal sound source like sounds from abnormal blood flow because of vascular anomalies or palatal myoclonus. Tinnitus, the perception of sound in the absence of a corresponding sound source, is a frequent disorder.
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