Musical hallucinations remain rare, are more common in women, and their onset is often related to ear pathology, particularly deafness. When brain disease is involved, pathology of the right or non-dominant hemisphere seems overrepresented. Psychosis and personality traits play a minimal role in their development. A discriminant function was constructed that correctly predicted the presence of brain disease (89%) and included the following clinical variables: being male, having acute onset musical hallucinations, and absence of deafness, psychiatric disease, and other forms of hallucination.