Migraines Secondary to PTSD

Overview

Migraines are recurring headache attacks, often with nausea and sensitivity to light and sound. If your PTSD is service connected, migraines can be service connected on a secondary basis under 38 CFR 3.310 when a medical opinion shows PTSD caused them or made them worse.

VA rates migraines under Diagnostic Code 8100 at 0%, 10%, 30%, or 50%, based on how often you have prostrating attacks. Migraine is rated in the neurological schedule, separately from the mental-health rating for PTSD, so a migraine rating combines with your PTSD rating.

What the Research Shows About PTSD and Migraine

• A consistent association. A 2026 systematic review (Nitsche et al., Headache) included 11 studies from five countries, covering military personnel, the general population, nurses, pregnant women, and students. Migraine prevalence was higher in people with PTSD (6.5% to 46.5%) than without (1.4% to 25.8%). Every study found a positive association, with ratios from 1.2 to 4.7. The authors described the association as strong and possibly bidirectional.
• Greater burden when both are present. In the U.S. National Comorbidity Survey-Replication (Rao et al., Headache, 2015), people with both migraine and PTSD reported about 8 days a month with reduced work quality, compared with about 2.6 days for migraine alone. They were also less likely to have worked for pay in the past week. This is relevant to the economic-impact language in the 50% criteria.
• Limits. These are mostly observational studies. They show that PTSD and migraine occur together more than chance would predict, but not that PTSD caused migraine in a particular person. Your records need to supply that link.

Proposed pathways. Poor sleep and nightmares, chronic stress and hyperarousal, and neck and jaw muscle tension are established migraine triggers, and all are common in PTSD. Researchers have also proposed shared stress-system and pain-processing mechanisms. You do not have to prove a mechanism; a clinician applies the evidence to your history.

Separate causes to rule in or out. Headaches after a head injury may be better claimed as secondary to TBI. Frequent use of pain relievers can cause medication-overuse headache. A good opinion addresses these instead of ignoring them.

How VA Decides the Claim

• Causation (38 CFR 3.310(a)): Migraines proximately due to service-connected PTSD are service connected.
• Aggravation (38 CFR 3.310(b)): If you had migraines before PTSD, VA compensates only the worsening. It needs medical evidence of your baseline attack frequency before the worsening, and it subtracts the baseline and any natural progression. Old treatment notes that record how often you had attacks are what establish the baseline.
• The opinion must answer both questions. An opinion that migraines are “not caused by” PTSD, with no aggravation analysis, is inadequate (El-Amin v. Shinseki, 26 Vet. App. 136 (2013)).

Evidence Requirements

• Current migraine diagnosis from any physician, specifying the type (with or without aura, episodic or chronic) if possible.
• Service-connected PTSD. Your rating decision.
• A medical opinion stating whether migraines are at least as likely as not caused by PTSD, and separately whether PTSD aggravated them. It should explain its reasoning with your timeline and address other causes.
• Headache log covering several months. Record the date, duration, symptoms, whether you had to stop and lie down (prostrating), medication taken, and any work missed.
• Treatment records for preventive and abortive medications, urgent care or ER visits, and specialist visits.
• PTSD records showing sleep disturbance, nightmares, and stress, particularly if clinicians noted headaches following them.
• Lay statements from people who have seen your attacks and their effect.
• Work records of missed days, leave use, or accommodations. These bear directly on the 50% criteria.

Rating Criteria for Migraines

Migraines are rated under DC 8100 in 38 CFR 4.124a:

0% Rating

Less frequent attacks than required for 10%.

10% Rating

Characteristic prostrating attacks averaging one in 2 months over the last several months.

Monthly compensation at 10% (single veteran, no dependents, 2026): $180.42

30% Rating

Characteristic prostrating attacks occurring on an average once a month over the last several months.

Monthly compensation at 30% (single veteran, no dependents, 2026): $552.47

50% Rating

Very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability.

Monthly compensation at 50% (single veteran, no dependents, 2026): $1,132.90

Key Rating Considerations

The difference between 30% and 50% turns on “very frequent,” “completely prostrating and prolonged,” and “severe economic inadaptability.” The Court of Appeals for Veterans Claims held in Pierce v. Principi, 18 Vet. App. 440 (2004), that “productive of” means producing or capable of producing severe economic inadaptability. You do not have to be unemployed. Document missed and shortened work days and attacks that stopped you from working. See our migraine rating guide for more detail.

How to File This Secondary Claim

1. Get a diagnosis if you do not already have one.
2. Keep a headache log for at least several months, because the criteria look at attack frequency “over last several months.”
3. Confirm PTSD is service connected by checking your rating decision.
4. Get a medical opinion that addresses causation and aggravation separately.
5. File VA Form 21-526EZ on VA.gov and list migraines as secondary to PTSD. Upload your log, records, opinion, and statements.
6. Attend the headache C&P exam. See our C&P exam guide.

C&P Exam Tips

• Bring your headache log and know your numbers: prostrating attacks per month, how long they last, and days of work missed.
• Describe what “prostrating” means for you, for example: “I have to lie down in a dark room, I vomit, and I can’t work for the rest of the day.”
• Describe a typical month and your worst months honestly. The examiner compares your account with your records. Accurate detail is more persuasive than broad statements.
• Explain triggers you have noticed, such as bad nights with nightmares, anniversaries, or high-stress periods.
• Report medication effects such as drowsiness from preventive medications that affect work.

Impact on Combined Rating

VA combines ratings with the 38 CFR 4.25 combined ratings table. Each step uses the table value, and only the final value is rounded.

Example 1: PTSD 70% + migraines 30%

1. 70% combined with 30% = 79
2. 79 rounds to 80%

At 2026 rates for a single veteran with no dependents, that is a change from $1,808.45 per month at 70% to $2,102.15 per month at 80%.

Example 2: PTSD 70% + migraines 50%

1. 70% combined with 50% = 85
2. 85 rounds up to 90%

Use our VA disability calculator to check your own numbers.

For personalized guidance on your VA disability claim, consult a VA-accredited VSO, attorney, or claims agent.