Phonophobia is abnormal discomfort or pain from ordinary sound levels during a migraine attack — the auditory counterpart to photophobia. The Greek root means “fear of sound”, but clinically the experience is discomfort, not fear.

Phonophobia is reported in roughly 75 percent of migraine attacks. It’s part of ICHD-3 1.1 criterion D, which requires either nausea/vomiting, OR both photophobia AND phonophobia, during an attack.

What it feels like

During a migraine attack:

  • Ordinary sounds become painful or intolerable — running water, refrigerator hum, normal speech.
  • Specific frequencies can be particularly intolerable — high-pitched sounds (children’s voices, sirens), some patients report bass frequencies.
  • Voices feel intrusive even at normal volumes.
  • Behavioural response — desire for silence, retreat to quiet rooms.

The mechanism likely involves the same trigeminovascular sensitisation and altered cortical processing that drives photophobia. Both phenomena reflect a general lowering of the threshold for sensory pain coupling during the attack.

Interictal phonophobia

Some patients with migraine — especially chronic migraine — report baseline sound sensitivity between attacks. This is the auditory analog to interictal photophobia. It’s not in the ICHD-3 criteria (which focus on the attack itself) but is clinically real.

If interictal phonophobia is severe or progressive, audiologic evaluation can rule out other causes (acoustic neuroma, otosclerosis, Ménière’s disease — rare but worth considering).

Practical interventions

Nothing specifically “treats” phonophobia — the most effective intervention is treating the underlying attack. During an attack:

  • Quiet environment — retreat to a low-noise room.
  • Foam earplugs — moderate sound reduction without isolation.
  • Noise-cancelling headphones playing nothing — works in environments where retreat isn’t possible (work, travel).
  • Limit conversation — even talking to someone can be exhausting.

For interictal sound sensitivity, sustained environmental controls (quiet workspace, sound-cancelling, choosing quieter restaurants) help. White-noise machines can sometimes help by masking variable sounds with consistent background.

What this isn’t

Not a recommendation that all migraine patients need noise-cancelling gear — most people manage attacks without it. Not a substitute for evaluation if sound sensitivity is new, severe, or accompanied by hearing changes — those need audiologic assessment.