Listening to headphones alone may cause tinnitus, but it does not cause pulsatile tinnitus. Pulsatile tinnitus generally has a characteristic frequency that matches that of the heartbeat and is most often caused by vascular lesions in the head and neck; in some cases it can be associated with myoclonus of the head and neck, and the rhythm of the tinnitus will match the rhythm of the clonus that occurs during a myoclonic episode. Therefore, pulsatile tinnitus is not caused by listening to headphones.