Migraines can be claimed as secondary to service-connected PTSD, anxiety or depression when a qualified provider’s opinion says it is at least as likely as not that the mental health condition caused or worsened them. VA rates migraines on their own, by how often you have prostrating attacks (diagnostic code 8100). VA decides each claim on its evidence.
How can migraines be secondary to PTSD or anxiety?
The rule is 38 CFR 3.310. A disability that is proximately due to or the result of a service-connected condition is also service connected, and so is added severity when a service-connected condition aggravates a non-service-connected one, if medical evidence shows the baseline level. For migraines you need:
- A mental health condition that VA has already service connected
- A current migraine diagnosis
- A medical opinion that the mental health condition caused or aggravated the migraines
A provider might point to poor sleep and stress, which are commonly reported migraine triggers and are common with PTSD, anxiety and depression. Some medications used for these conditions also list headache as a side effect. Whether any of that applies to you is for your providers to say. VA also decides whether migraines are a separate condition or a symptom of the mental health condition, because it does not rate the same symptom twice under different diagnoses (38 CFR 4.14).
What evidence helps a migraine claim like this?
- Your rating decision showing the mental health condition is service connected.
- Migraine diagnosis and treatment records, including when the migraines began or got worse compared with your PTSD or anxiety symptoms.
- A headache log with dates, duration, whether you had to lie down, medication, and what was going on, such as a night of nightmares or a panic episode. Our guide to a migraine evidence log shows what to track.
- A medical opinion that explains its reasoning from your records. It can come from any licensed provider, including your treating doctor, mental health provider or neurologist, and VA does not require a paid one. Woobie provides medical consulting and educational resources, including independent medical opinions from licensed providers for a flat fee that does not depend on your outcome. Woobie is not a law firm or an accredited claims agent and does not file claims. See what a VA nexus letter is.
- Medication notes. If you think a medication is triggering headaches, tell your prescriber and ask that it be recorded.
How does VA rate migraines?
VA’s criteria for migraine (38 CFR 4.124a, code 8100) are:
- 0%: less frequent attacks
- 10%: characteristic prostrating attacks averaging one in 2 months over the last several months
- 30%: characteristic prostrating attacks occurring on average once a month over the last several months
- 50%: very frequent, completely prostrating and prolonged attacks productive of severe economic inadaptability
Our guide to the VA migraine rating explains how frequency and severity fit together.
What are prostrating attacks and economic inadaptability?
In everyday terms, a prostrating attack is a migraine severe enough that you have to stop what you are doing and lie down, often in a dark, quiet room. VA decides whether your attacks count, so records should describe what you can and cannot do during one and how long it lasts.
“Severe economic inadaptability” is part of the 50% criteria. The criteria do not list examples. Veterans often gather sick leave records, missed days, reduced hours, early departures and statements from supervisors or coworkers. VA decides what meets the standard, and results vary. For other conditions that can develop alongside PTSD, see our guide to secondary conditions linked to PTSD.
Frequently asked questions
Can migraines be secondary to anxiety or depression, not only PTSD?
The secondary rule applies to any service-connected condition. If VA has service connected your anxiety or depression, a provider can say whether it caused or worsened your migraines. VA decides based on the medical evidence in your claim.
What if my migraines started before my PTSD?
VA can service connect added severity if a service-connected condition aggravates a non-service-connected one, but it needs medical evidence of the baseline level before the aggravation. A provider’s opinion and records from before and after the change matter here.
Can I be rated for migraines if my MRI was normal?
Yes, in principle. VA’s migraine criteria turn on how often you have prostrating attacks, not on scan results, and imaging in migraine often looks normal. Records and a headache log that show frequency over several months are what the criteria call for.
Can a medication side effect support a migraine claim?
That is for VA and your providers to decide on the medical evidence. If you think a medication for a service-connected condition is triggering headaches, tell your prescriber and ask that it be recorded in your chart.
Do I need a nexus letter for migraines secondary to PTSD?
VA does not require a paid one. A medical opinion can come from any licensed provider, including your treating doctor, and the standard is whether the link is at least as likely as not. Opinions are stronger when they explain their reasoning from your records.
Questions about your medical evidence? Woobie offers a free consultation to talk through your situation. Woobie is not a law firm or an accredited claims agent and does not file claims. Schedule a free consultation →