Abstract
BACKGROUND: Severe headache or migraine symptoms are a highly prevalent and disabling neurological disorder with distinct clinical and mechanistic features in peri- and postmenopausal women. As research increasingly explores its complex sensory phenotype, auditory comorbidities such as tinnitus have drawn growing attention. Among them, the temporal constancy of tinnitus may be linked to severe headache or migraine symptom occurrence, yet remains understudied in this population. METHODS: A total of 2,485 peri- and postmenopausal women from a nationally representative U.S. sample were included in this observational analysis. The target variable was severe headache or migraine symptoms, defined using standardized symptom and medication information. The main explanatory variable was tinnitus constancy, derived from standardized questionnaire items. Weighted multivariable logistic regression models were used to estimate the association between tinnitus constancy and severe headache or migraine symptoms, adjusting for demographic, socioeconomic, and clinical factors. Variable importance was further assessed using five complementary approaches: LASSO regression, logistic regression, random forest classification, the Boruta algorithm, and SHAP-based LightGBM modeling. RESULTS: A significant and graded association was observed between tinnitus constancy and severe headache or migraine symptoms. Compared to women without tinnitus, those with occasional (OR = 2.29, 95% CI 1.44-3.63), intermittent (OR = 2.62, 95% CI 1.57-4.35), and constant tinnitus (OR = 1.93, 95% CI 1.26-2.95) had higher odds of reporting severe headache or migraine symptoms. Intermittent tinnitus displayed the strongest association. Age was negatively associated with symptom reporting and consistently ranked as the most important predictor across all machine learning algorithms. SHAP dependence plots confirmed elevated symptom probability among younger individuals and those with more variable tinnitus patterns. CONCLUSIONS: Tinnitus constancy, particularly in its intermittent form, is independently associated with higher odds of severe headache or migraine symptoms in peri- and postmenopausal women. Age was also a dominant protective factor. These findings highlight the importance of considering the temporal patterns of tinnitus symptoms and age-related vulnerability when evaluating severe headache or migraine symptoms in peri- and postmenopausal women.