Musical hallucination (musical tinnitus)
Causes and treatments for musical hallucination which is the experience of hearing music when none is being played.
What is musical hallucination?
You may be familiar with “earworms”, where a snatch of song or jingle gets stuck in your head once you’ve heard it. Musical hallucination or musical tinnitus is also the experience of hearing music when none is being played, but it tends to be longer lasting, and doesn’t mirror any external music you may have heard recently.
Hearing sound that no-one else can hear is quite common and is called tinnitus. This experience is normally of a simple sound such as a buzzing, ringing, or sizzling. For some people however, these experiences can be more complex and emotive, and music can be heard.
In most people with musical hallucination, there is no underlying cause. There is not thought to be a connection to mental health conditions.
The intrusiveness of musical tinnitus can be managed with the techniques used to treat other forms of tinnitus.
What is musical hallucination like?
Musical hallucinations have a compelling sense of reality and are often mistaken for real music until it becomes clear that none is being played. This is especially true when musical hallucinations are experienced for the first time. The sounds are typically heard as short fragments of simple melodies - often from music heard regularly and familiar from childhood such as songs played in school or church, national anthems and snatches of classical music. People with hearing loss sometimes notice that they hear the music in the hallucinations as they first did. So, it is not muffled or quieter or with frequencies missing as it is with their current level of hearing loss.
Who gets musical hallucination?
Although anyone can experience musical hallucination, there are some groups of people where it is more common. This includes people who live alone, and people with hearing loss. It is also more common in women than men and in people over 60 years of age. What causes musical hallucination?
In most people, there is no underlying cause found.
Very rarely, it can be caused by serious conditions, for example by problems with the blood vessels in the brain or by brain tumours. In these conditions there are likely to be other symptoms, but your doctor might choose to perform some investigations to rule them out.
Musical hallucination is also more common in individuals who have epilepsy or Alzheimer’s disease. It is therefore very important to mention to your doctor if you have musical hallucination and experience changes in your vision, dizziness, severe headaches, problems with your speech or difficulties with movements.
Is it caused by my medications?
Like tinnitus, a number of medications have been accused of causing or contributing to musical hallucination. However, nothing has been proved with the exception of medications based on opium, such as tramadol, morphine sulphate and oxycodone, which have been shown to cause musical hallucination in rare cases.
If you believe that your musical hallucination might be caused by one of these substances or another medication, it is important that you do not stop taking it or adjust the dosage without first discussing this with your GP or the doctor who prescribed the medication.
Is musical hallucination a psychiatric problem?
The majority of individuals with musical hallucination do not have any psychiatric disturbance.
Some people with musical hallucination worry that it might be a symptom of a mental health condition, such as schizophrenia. Although in schizophrenia it is common to hear voices, it is in fact very rare to experience musical hallucination and there is thought to be no connection between the two conditions.
Musical hallucination is quite common in people who have obsessive compulsive disorder (OCD), in which they experience repetitive, intrusive and distressing thoughts and feel strong urges to repeatedly perform actions. It is estimated that around four in ten individuals with OCD will experience musical hallucination at some time in their life. It is important to note that the majority of individuals with musical hallucination do not have OCD.
Can musical hallucination be treated?
If musical hallucination has an underlying cause, addressing the cause will often relieve the hallucination. It might be appropriate to use medication to treat the underlying condition and your doctor will be happy to discuss this with you.
The most common cause is hearing loss. Your doctor will probably ask you to have a hearing test. Based on the results of this, they may prescribe a hearing aid.
Many people find that musical hallucination becomes less intrusive once the condition has been explained and they are reassured that there is no serious underlying cause. If it continues to be troublesome despite this, it can be managed with the techniques used to treat other forms of tinnitus.
Author: Dr Thomas E Cope, PhD MRCP (Neurology), Consultant Neurologist, Addenbrooke’s Hospital, Cambridge
Issued: October 2022
To be reviewed by October 2025
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Piano by Anastasia Kolchina on Pexels.