EVERYTHING ELSE
EARWORMS (songs stuck in your head)
For an overview of this subject, please see the 9/6/25 post on my Substack NICE Ideas newsletter at NiceIdeas.substack.com.
LETTER TO PROSPECTIVE RESEARCHERS
I am a sufferer of what have been called by researchers “involuntary (or intrusive) musical imagery” (INMI) and “musical obsessions,” or, as I think of them now, “pathological earworms.”
More than 100 sufferers from all over the world have contacted me through my blog on this subject. And evidence suggests these are only the tip of the iceberg. We are tortured by these repetitive snippets of songs that can become so “loud” we cannot hear our own thoughts, we can never relax, and we can never enjoy even one second of quiet, dreaming or awake, sometimes for months or even years.
We desperately need help, whether directly or through referrals to other researchers. And we are eager to help any researchers in any way we can, including as subjects for testing.
This letter is to ask you to please explore an aspect of this pathological form of the earworms experience that, so far, no researchers appear to have studied before: the chemistry.
This letter includes a brief sampling of patient reported outcomes (PROs), and it offers questions and ideas that we hope might lead to practical solutions for us all.
The 500 pound gorilla in the room
As I’ve read papers and articles published on the subject, I have sometimes nearly screamed at the pages, pointing out the 500 pound gorilla in the room that nobody seems to be talking about.
Discussions dance all around it, noting that stressful situations sometimes precede episodes, stress seems to make the earworms worse, the stress of trying to suppress them makes them worse, and perceiving them negatively (stress) makes them worse. But as far as I can tell, nobody talks about the chemical aspects of stress and how they relate to earworms.
Please forgive my frustration. I just feel that the answers we seek are so close, if only someone would look “in the right place.”
1. The State of the Science
A recent review of the literature on the subject of earworms and musical obsessions reveals that several aspects of the phenomenon have been studied/documented since 1953, though more interest has arisen since the turn of the millennium. None of them appear to explore chemical connections.
1.1 What researchers currently knowCurrently documented aspects of the earworm phenomenon include the following:
- Characteristics of songs that seem “stickier” than most.
- Possible features of memory that might be involved in the common earworm phenomenon.
- The methods by which common earworms can be induced in normal subjects.
- How people with common earworms handle them or get rid of them.
- The psychological profile of the casual/common earworm experiencer.
- The association between earworms and obsessive compulsive disorder (OCD).
- The effect of active resistance to earworms versus acceptance.
- The importance of music to the sufferer.
- Coping/treatment methods, including the use of psychoactive drugs.
- The prevalence and duration of earworms (common and pathological).
- The neurological conditions in earworm sufferers as measured by MRIs and EEGs.
- Cortical structure in those prone to common earworms.
- Features of musical obsessions in case studies.
1.2 Currently proposed research
Suggestions for future research all have one thing in common: no proposed investigation into the chemistry of earworms, especially of earworms, as far as I can tell.
1.3 What’s missing
Among the most significant (to me) features of this phenomenon researchers and clinicians seem to be missing are:
- It’s not about sticky music, it’s about a sticky brain. Though it would be more appropriate to call it a “magnetic” brain. Only certain things stick to a magnetic brain.
- It isn’t about the persistence of a given song, it’s about the duration of the “magnetic brain” episode. For us, an earworm “episode” begins when the brain becomes magnetic and songs start to stick in it. This episode can then last for years.
- It’s not so much about the sufferer’s psychology. The personalities and other characteristics of those who have found my blog seem to be all over the map. Chemistry, not psychology, appears to be the primary common denominator connecting us.
- It’s not bothersome because we resist it or because we judge it to be a bad thing; it’s bothersome because it’s a gigantic, objectively disruptive pain in the ass.
- Psychoactive drugs may be triggering the earworms in many people. A significant proportion of earworms sufferers did not have this problem until after they took psychoactive drugs for some other condition such as depression or anxiety (though they may have been caused by stress).
- The fact that some people with OCD also have earworms doesn’t mean all people with earworms have OCD. A 2010 review identified 96 OCD patients with earworms documented over a 60-some year period. Yet, just in the past seven years since I started my blog, more than 100 earworms sufferers have found me online, with only a few having been diagnosed with OCD.
- Looking in all the wrong places. Conducting polls or epidemiological studies of earworms in busy public places or among listeners of the radio won’t find us because we aren’t there.
- Our avoidance behaviors are not maladaptive. Imagine that you suddenly became powerfully magnetic. You wouldn’t consider it maladaptive at all to avoid knife stores or the nail and sawblade aisles at the hardware store. In fact, you’d think it supremely logical and wise to consider all the environments in which your magnetism might cause you harm and then to avoid those environments until you figured out what caused your magnetism and how to turn it off.
- The earworms can last WAY longer than a few days. One article says, “The majority of us experience [earworms] for only short periods—perhaps a few minutes—but others can experience them for two or three days, which can be extremely frustrating and debilitating.” Imagine how someone who has had severe, unabated earworms for YEARS feels.
- You can put a subject in a scanner and expect an earworm to come along. There are at least 100 of us out here who could walk into a lab any day of the week and show you what pathological earworms look like in an fMRI or other functional brain scan. Please study us!
This letter cannot possibly cover the breadth and depth of the earworm experience. But this section provides a snapshot of the general experience as well as a few brief case studies / Patient Reported Outcomes (PROs).
2.1 The earworms experiences
- When mild, the experience is present in the background of our minds. We can be distracted from them for periods of time, only to have them reemerge when we are not busying our minds.
- They may consist of one or two songs, or one or two snippets from the same song. The snippets range from 10 seconds to about 30 seconds in duration.
- We do not need to have actually heard the song for it to stick. We could compose a song completely in our heads and that can get stuck just as easily as something we’ve heard.
- While specific songs may retire after weeks or months only to be replaced with others, the brain stickiness/magnetism can persist for many months or many years.
- We do not need to be consciously aware of having heard songs for them to get stuck.
- At their worst, the earworms can become so “loud” we can’t hear own own thoughts, and so pervasive we can’t escape them even in sleep. They wake us from torturous dreams and, during the day, keep us from creating, imagining, concentrating, and sometimes even comprehending.
- We can have multiple song snippets playing all at once, taking turns in “the spotlight.”
- Any vaguely rhythmic or melodic pattern can also get stuck when our brains are sticky/magnetic. I once noticed a rhythm of the expansion strips in the concrete as I drove along a certain stretch of highway, and that rhythm became a “song” that stuck. I have also had unfamiliar words and names get stuck after I tried to pronounce them in my mind.
2.1.1. What triggers or exacerbates them
- Stress. Many sufferers had their first earworms episode after some traumatic event or period of emotional distress. Others, especially musicians, got them after intensive (stressful) studying or rehearsals. Virtually all sufferers report that stress makes their earworms worse.
- Psychoactive drugs. A surprising number of sufferers got their first earworms after taking psychoactive drugs for some other reason (such as depression, anxiety, psychosis, or seizures). My own earworms came back (after years of silence) when I tried Wellbutrin for three days in hopes it would restore my libido after menopause. For many who seek help, the drugs they’re given make the earworms worse. Only a small percentage gain relief from drugs.
- Infections/inflammation. Some sufferers did not have earworms until after they experienced a severe infection, typically treated with antibiotics. Some episodes started after brain injury.
- Insulin resistance. At least one sufferer had a confirmed insulin resistance condition that was only diagnosed after his earworms emerged. (See “The Twins” case study.) Several others have casually reported symptoms of possible insulin resistance (carb/sugar cravings).
- Hormonal changes. Several women, including myself, first got earworms after experiencing major hormonal changes. Most of those cases related to menopausal changes. But one young woman’s case happened after the birth of a child and treatment for post-partum depression.
2.1.2 What quiets or tames them for some sufferers
- Phosphatidylserine (reduces cortisol)
- Sex hormone adjustment (pregnenolone, estrogens E2 and E3, progesterone, testosterone)
- Prednisone (reduces cortisol and inflammation), though some report the earworms get worse
- Relora (reduces cortisol)
- Eliminating food allergies (reduces inflammation, which improves insulin resistance)
- Treating diabetes and/or insulin resistance
- B vitamins (help manage stress and metabolism of glucose)
- NAC / n-acetyl cysteine (reduces cortisol)
- Inositol (reduces OCD symptoms and anxiety)
2.2 Selected case studies / patient reported outcomes (PROs)Me (Pat)
I was middle-aged when I developed earworms. For more than a year I was tormented by them, all day and even in my sleep, until I thought I could not survive if I didn’t get relief.
Neurological tests showed no abnormalities; drug treatment was suggested. Eventually I asked my gynecologist if this might be an unusual sign of menopause, even though I still had periods, however erratic. He said, “This is either a thyroid problem or a brain tumor...and you don’t have a brain tumor!” Turned out my sex hormones were, in fact, extremely low. The doctor started me on horse hormones and synthetic hormones (Prempro) and the music went away almost immediately.
Still, I didn’t want to be on alien hormones indefinitely, so I switched doctors and started on bio-identical hormones (estradiol/E2, progesterone, pregnenolone). The earworms came back somewhat until I found the optimal balance of hormones and they went away. Years later they returned with a vengeance when I took Wellbutrin for 3 days. And although they faded, they were never completely quiet after that.
However, in the first several months of this year (2017) the earworms had begun to creep back in. During this same period I had been struggling with estrogen patches that seemed to be less effective than before. Additionally, I had been using a cheaper brand of phosphatidylserine (PS). I recently switched back to the more expensive brand, and the earworms are once again fading.
The Twins
In 2010, Diane contacted me. Her six-year-old son, David, shouted all the time. His hearing tested fine. When asked why he shouted, he said he did it so he could be heard over all the loud music (earworms). David was an identical twin, and only he had the earworms. David also differed from his twin brother in that he craved and ate simple carbs almost exclusively. He also drank abnormal amounts of water.
I suggested David see a doctor about possible insulin resistance. Tests showed he was mildly diabetic. Once he received treatment, his earworms subsided.
RON
Ron began his one-song earworm episode after a devastating relationship breakup that left him with depression and severe anxiety/panic. As of 2013 when he contacted me, his earworm had been playing constantly for four years. Saliva tests eventually indicated he had inverted cortisol levels, and severely low levels of numerous neurotransmitters (epinephrine, norepinephrine, dopamine and serotonin). When he took naturopathic adrenal supplements AdreCor and TravaCor, the anxiety/panic stopped within 24 hours. However, a new earworm song took over and continued throughout my correspondence with him, though it didn’t bother him as much as before he addressed his adrenal issues.
Ron has had many treatments (all of which failed to relieve the earworms) including: seven sessions of electroconvulsive therapy (ECT), gamma knife surgery (anterior capsulotomy for presumed intractable OCD), repetitive transcranial magnetic stimulation (rTRMS), and hypnosis. He has also tried several drugs (clonazepam, haloperidol, risperidone, mirtazapine, Adderal, and Zoloft) with no success.
ANNA
Anna is a 25-year-old woman whose earworms began when she was 20 and had a very stressful life. As of early 2018, the earworms have been constant for more than five years. They are disruptive, interfering with her sleep and her studies. Stress makes the music louder. She rates the earworms’ disruptiveness at 8-10 on a 10-point scale.
She has tried more than 30 different SSRIs, as well as antipsychotics, none of which have helped. Her doctors initially diagnosed her with OCD because of the earworms alone. However, after she began OCD drug treatments for her earworms, she developed new obsessions. Recent labs indicate her morning cortisol was normal (no other cortisol tests were done) and her insulin level was high.
3.0 The chemical hypothesis
Based on the common denominators of many of the earworm sufferers cases, I propose that insulin resistance and/or cortisol directly may play critical roles in triggering and/or promoting these earworms, though the true cause is surely far more complicated.
“Importantly, the stress-response and the activity of the hypothalamic-pituitary-adrenal (HPA) axis have been shown to be relevant in the context of several psychiatric disorders (Holsboer, 1983). This also holds true for OCD as it is known that stressful events may precede the onset of OCD (Toro et al., 1992) and that, in addition, OCD symptoms increase at times of stress (Findley et al., 2003). “ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3613755/
However, most of us have been stressed earlier in our lives without our ever developing earworms. This prompts so many questions: ●Is this a multi-stage process where some other circumstances first predispose our brains to react to stress or chemicals in an abnormal way? ●Is this dysfunction a case of improperly recalling and perpetuating musical memories, or is it a failure to extinguish those memories normally? ●What are the normal mechanisms for moving conscious thought into the background? ●Are those mechanisms different for music than for other thoughts? ●Why could I get “high” on music, say three years ago, and not get earworms at all, but now any kind of music sticks to my magnetic brain? ●Are earworms perhaps a symptom of something more fundamental going wrong, like the damage done to a brain from excess glucose or excess cortisol or unrelieved inflammation? ●Do alien (non-bioidentical) steroids (like prednisone and Prempro) quiet the earworms because they can’t metabolize as efficiently as their natural/bioidentical counterparts? And if so, what are the implications for earworms? ● Do people with “forgetting” conditions (like Alzheimer’s) get earworms? ●Could the effect of excess cortisol in the brain be like excitotoxins that overstimulate neurons to death? ●How could something (cortisol) that impedes the brain’s ability to form memories be involved in replaying musical memories? ●What is the significance of the short period of the earworm snippets vis-a-vis brain/memory function? ●Since the hippocampus tells the adrenals to stop producing cortisol (and assuming high cortisol is associated with earworms), can we test the hippocampus, and if it’s malfunctioning, can it be repaired?
Clues that led to the chemical hypothesis include the following:
- Severe stress often precedes the initial earworm episode. Stress almost universally exacerbates it.
- Stress stimulates the production of cortisol, perhaps other hormones as well.
- Prednisone stops or quiets earworms for some people; prednisone reduces natural cortisol and it reduces inflammation.
- Cortisol-lowering supplements also seem to reduce the severity of earworms.
- Researchers of depression and OCD have found significant cortisol and HPA-axis connections.
- Excess cortisol can cause insulin resistance.
- Anything that causes inflammation in the body also can trigger insulin resistance. Allergies, injuries, and infections can cause inflammation.
- Menopause and childbirth have been associated with earworms, and both involve chemical imbalances, especially estrogen and progesterone. Progesterone and cortisol compete for the same cell receptors. Estrogen enhances insulin sensitivity.
I am not a scientist, so I/we must rely on professionals like you to formulate proper hypotheses and meaningful studies. That said, I would like to see research done that investigates the following:
- Differences between active earworms sufferers and normal subjects. Determine what factors (measured by scans, labs, and surveys) differentiate active earworms sufferers from normal subjects with no earworms, both under “quiet” (no music) conditions.
- Scans might include static scans as well as dynamic scans using fMRI, PET or SPECT.
- Labs for various studies might look for patterns in chemicals such as cortisol, adrenalin, insulin (and measures of insulin sensitivity/resistance), DHEA-S, ACTH, CRP, estradiol, estriol, testosterone, progesterone, pregnenolone, serotonin, dopamine, GABA, norepinephrine, oxytocin and endorphins, and perhaps patterns in IgG food allergy tests.
- Surveys would collect information that might reveal meaningful patterns and clues.
- Same as #1 plus music exposure. Expose each subject to a song he/she likes. Survey subjects about the level of pleasure they feel from that song (separate from the earworm torment). 0=No opinion; 1=Pleasant; 2=Like; 3=Love (the song/performance makes me feel “high”)
- Effect of dexamethasone in earworms sufferers with high cortisol levels. If the excess cortisol is related to excess ACTH from the pituitary, then it seems dexamethasone should suppress cortisol levels, and the earworms should fade or stop. (What can we measure if pituitary isn’t the problem?)
- Further detailed studies of earworms sufferers. Look deeper into any significant associations with specific chemicals and/or chemical/neurological patterns discovered in #1 and #2.
- Test any earworms sufferers who can turn it on and off. If we can find more such subjects (as I may be again soon), test them with and without the earworms.
- Test two otherwise identical/similar subjects where one has earworms and the other doesn’t. Ideally we could find a set of twins, like Dana’s, to determine what is different in the one with earworms.
- Survey people with high-cortisol and/or insulin-resistance conditions to look for prevalence of earworms among them. (Diabetes, Cushing’s syndrome, etc.) Results may suggest future studies.
- Neurochemical studies similar to those done for cortisol/HPA axis connections in OCD and depression.
5.0 A request and an offer, with deepest gratitude in advance
This is to humbly ask for your help in this quest for answers and solutions. If you cannot pursue this research, please recommend (and ideally make introductions to) other researchers you believe might be able to help us.
Should you choose to pursue such investigations, I will provide all information I have gathered from earworm sufferers, researchers, and my own experiences. I offer myself as a guinea pig for your studies and will connect you with a large number of sufferers who may also be willing to participate.
My smallest hope is that even just one expert like you will step forward to tackle this challenge. In a perfect world, many would take it on, collaborating, exploring different dimensions of the puzzle simultaneously. In any scenario where someone agrees to help us, we offer our deepest gratitude.
Thank you so much for your time and interest in this subject.
Please contact me here.
