Ross Hauser, MD
Misophonia is a condition where sounds—such as chewing, breathing, tapping, or repetitive clicking—trigger intense emotional and physical reactions. These reactions often include anger, anxiety, panic, muscle tension, and rapid heart rate. While research has primarily focused on how the brain processes these sounds, some patients with upper cervical spine instability report similar symptoms, raising the question of whether neck instability could contribute to or worsen misophonia in some individuals.
In our clinical observations, many patients with cervical spine instability show additional symptoms that overlap with those reported in misophonia. These may include headaches, brain fog, dizziness, tinnitus, visual disturbances, panic attacks, and increased sound sensitivity (hyperacusis). This can suggest a shared physiological mechanisms.
One possible mechanism involves dysfunction of the autonomic nervous system. The upper cervical spine lies close to nerves involved in regulating the body’s stress response, including the vagus nerve and the upper cervical sympathetic nervous system. If cervical spine instability alters the function of these structures, it could promote an exaggerated “fight-or-flight” response. This may help explain why relatively harmless sounds provoke immediate physical and emotional reactions in some individuals with misophonia.
Another possible mechanism involves the brainstem. The upper cervical spine is anatomically adjacent to the brainstem, which plays a central role in processing auditory information, regulating autonomic function, and integrating sensory input. Significant cervical instability could influence these pathways through altered mechanical forces, vascular changes, or abnormal sensory input from the neck.
A November 2022 paper in the Journal of affective disorders (1) lead by doctors at the Baylor College of Medicine assessed patient outcomes in the various treatment approaches for misophonia.
The researchers write: “While there is no uniformly accepted treatment to date, different intervention approaches are being investigated. Individual’s perceptions of different misophonia treatment methods may affect compliance and satisfaction with treatment options.” The problem is in the patients not believing the treatments would help them. This was study in both adults (252 patients) and children (141 patients) with misophonia.
Here are the summary findings: “Most respondents were not satisfied with misophonia treatments that they or their children had previously received. Audiologic interventions including active and passive noise cancelling and lifestyle modifications were rated as most appropriate for treatment of misophonia by both parent and adult respondents.” However, the researchers concluded: “Most interventions are considered inappropriate by parents of youth with misophonia and by adults with misophonia. This should be interpreted in the light of a general lack of misophonia-specific interventions. (Treatments specifically geared at misophonia).
Misophonia and paranoia-like thoughts
A November 2022 paper published in the journal Schizophrenia research (2) examined the relationship between misophonia and paranoia-like thoughts.
The research team from the Institute of Psychology, Polish Academy of Sciences, explained the relationship between misophonia and paranoia-like thoughts in this way: “Misophonia is a complex syndrome in which selective auditory stimuli, such as sounds of breathing, sniffing or eating, trigger an intense, negative emotional response. Previous studies have shown that the symptoms of misophonia coexist with a number of mental disorders, such as OCD, depression and anxiety.” In this study 312 people were examine to see what factors might underlie the potential relationship between misophonia and paranoia-like thoughts. Factors included “difficulties in regulating emotions, anxiety and hostile attributions.
Interventions targeting anger, anxiety, and nonacceptance
In an August 2025 study (3) of 265 misophonia patients, msophonia severity was most strongly associated with emotional awareness, nonacceptance, anxiety, and anger. . . Interventions targeting anger, anxiety, and nonacceptance may be most effective in managing misophonia symptoms.
A July 2025 study in the journal Frontiers in neurology (4) Misophonia is a common and clinically significant comorbidity in migraine, associated with heightened sensory sensitivities, increased psychiatric burden, and greater functional impairment. In this study, researchers found a significantly higher prevalence of misophonia among individuals with migraine compared to healthy controls (44.9% vs. 17.6%).
The authors suggest the co-occurrence of these conditions may be underpinned by shared neurobiological mechanisms neurotransmitter dysregulation (your brain is getting or altering messages leading to dysfunction) and altered brain connectivity.
In our opinion, in some patients the underlying cause may be cervical spine instability.
Read further
Meniere’s Disease and hearing problems caused by cervical neck instability
Ross Hauser, MD Reviews Cervical Spine Instability and Potential Effects on Brain Physiology
References
1 Smith EE, Guzick AG, Draper IA, Clinger J, Schneider SC, Goodman WK, Brout JJ, Lijffijt M, Storch EA. Perceptions of various treatment approaches for adults and children with misophonia. Journal of affective disorders. 2022 Nov 1;316:76-82. [Google scholar]
2 Bagrowska P, Pionke-Ubych R, Gawęda Ł. Do they make these sounds to hurt me? The mediating role of emotion regulation, anxiety and hostile attributions in the relationship between misophonia and paranoia-like thoughts. Schizophrenia Research. 2022 Dec 1;250:137-42. [Google scholar]
3 Hanna MR, Collins AC, Shan Y, Chen B, Wang S, Rosenthal MZ. Examining the role of emotion regulation, anger, and anxiety in misophonia: A network model. PloS one. 2025 Aug 18;20(8):e0329920. [Google Scholar]
4 Sahin A, Cakir S, Ilgaz Aydinlar E, Ertas M, Yalınay Dikmen P. Assessing misophonia as a potential comorbidity in migraine patients compared to controls: a cross-sectional study. Frontiers in Neurology. 2025 Jul 16;16:1545520. [Google Scholar]