Sudden hearing loss is common, but unexplained in many cases. Although usually attributed to a viral infection of the inner ear in most patients, the abrupt onset of the hearing loss in many patients argues against a viral etiology. We present 13 cases of unexplained sudden hearing loss who meet the diagnostic criteria for migraine. All had the sudden onset of hearing loss and other neurologic phenomena that could be attributed to vasospasm, including vertigo, amaurosis fugax, hemiplegia, facial pain, chest pain, and visual aura. We suggest that vasospasm of the cochlear vasculature was the cause of the sudden hearing loss in these patients. A personal and family history of migraine should be sought in patients with sudden hearing loss and when found, a trial of antispasmodic agents should be considered.