If only pulsatile tinnitus is present at night, normal physiological causes are most often considered. Because the side of the head is placed on a pillow during sleep at night, the arteries in the temporal or ear area are partially blocked by acoustic pressure and pulsatile tinnitus can occur due to the blockage in the ear itself and reduced ambient noise. Alternatively, it cannot be ruled out that pulsatile tinnitus can be caused by a vascular lesion in the head and prompt medical examination is recommended.