Migraines are a debilitating condition that can significantly impact an individual’s quality of life. For veterans, migraines may be connected to their military service and could qualify as a service connected disability through the Department of Veterans Affairs (VA).
In this article, we will explore the basics of migraine headaches, the process of undergoing a Compensation and Pension (C&P) exam for migraines, and how the VA assigns disability ratings under 38 CFR 8100 for this condition.
Disease Overview
Migraine headaches are a common and often disabling condition that causes recurring headaches and can greatly affect daily life. According to the International Classification of Headache Disorders, migraines are usually one-sided, throbbing headaches that last between 4 and 72 hours. They are often accompanied by symptoms like nausea, vomiting, sensitivity to light (photophobia), and sensitivity to sound (phonophobia). A severe form, called “prostrating migraine,” causes such intense pain that individuals are unable to carry out normal activities during an attack. If not properly managed, migraines can last longer and may develop into chronic migraines, where the headaches occur more frequently over time. 1,2,3
Doctors diagnose migraines by evaluating a patient’s headache history and symptoms, using specific criteria outlined by the International Classification of Headache Disorders. This may include checking for triggers such as stress, poor sleep, or certain foods. Imaging or lab tests may also be used to rule out other causes when necessary. Migraine triggers like sleep disturbances and diet can make the condition more complicated to manage. 3,4,5,6
Migraine treatments fall into two main categories: acute and preventive. Acute treatments focus on relieving symptoms during an attack and include medications like nonsteroidal anti-inflammatory drugs (NSAIDs), triptans, and newer options such as monoclonal antibodies that target calcitonin gene-related peptide (CGRP). Preventive treatments are recommended for people who experience frequent or chronic migraines and may include beta blockers, anticonvulsants, or CGRP inhibitors to reduce the number of migraine days. However, many people do not use preventive treatments, even though they can be highly effective. 1,3,7,8,9
Migraines can be caused by a variety of internal and external factors. Common triggers include stress, hormonal changes, lack of sleep, and certain foods. Migraines are also linked to other medical conditions, such as anxiety, depression, or medication-overuse headaches, which can make migraines worse. For example, people with depression often experience more severe and frequent migraines compared to those without depression. 5,6,10,11
Mental health plays an important role in migraines. Stress, anxiety, and depression can increase the frequency and severity of migraine attacks, creating a cycle where migraines and mental health issues influence each other. This makes it important for doctors to address both physical and psychological factors when treating migraines. 11,12,13
Veterans experiencing 8100 Migraine symptoms should document them in a Statement in Support of Claim.
History of Migraine
During a C&P exam, the veteran’s migraine condition is documented in the Headaches DBQ.
Section II is designated for the examiner to record the veteran’s medical history related to their migraine condition, including any medications being used to manage the symptoms.
Section III focuses on documenting the symptoms of the veteran’s migraine headaches. This section includes questions about the type of headache pain, whether it is constant or pulsating, if it occurs on one or both sides of the head, and if the pain worsens with physical activity. It also addresses non-headache symptoms such as nausea, vomiting, sensitivity to light and sound, changes in vision, or sensory changes like pins and needles in the hands or feet. Additionally, this section includes questions about the typical duration and location of the head pain.
Section IV pertains to the migraine rating schedule for VA disability. This section specifically asks about the presence of prostrating headache attacks and their frequency. It also inquires about completely prostrating and prolonged attacks of headache pain, if they occur, and how frequently they happen.
Physical Examination for Migraine
During VA disability evaluations for migraines, C&P examiners do not conduct physical examinations.
Testing for Migraine
Section VI focuses on diagnostic testing. In this section, the examiner will record any tests that have been performed, such as MRIs or CT scans of the head. C&P examiners do not order tests to diagnose or confirm a migraine condition. Instead, they rely on the information provided in the claims file. Therefore, it is important for the veteran or their representative to send medical treatment records to the VA Intake Center before the C&P examination to ensure the diagnosis is properly documented.
Ratings for Migraine
Veterans seeking disability ratings for migraine can refer to diagnostic code 8100 in the 38 CFR.
- 0 % Rating
- With less frequent attacks
- 10% Rating
- With characteristic prostrating attacks averaging one in 2 months over last several months
- 30% Rating
- With characteristic prostrating attacks occurring on an average once a month over last several months
- 50% Rating
- With very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability
The degree to which headaches impact the ability to work is an important factor when considering a 50-percent disability evaluation.
The M21-1 defines key terms as follows:
- Prostrating (as defined in 38 CFR 4.124a, DC 8100) means causing extreme exhaustion, weakness, debilitation, or incapacitation, with a significant inability to perform everyday activities.
- Completely prostrating refers to extreme exhaustion or weakness that results in an almost total inability to engage in normal daily activities.
- Severe economic inadaptability indicates a significant level of work-related impairment but does not mean the person is incapable of performing any substantially gainful employment. Evidence of work impairment may include, but is not limited to, the use of sick leave or unpaid absences.
The frequency of characteristic prostrating attacks is classified as:
- Less frequent: Attacks occur, on average, more than two months apart over several months.
- Very frequent: Attacks occur, on average, less than one month apart over several months.
To evaluate a veteran’s headache claim, the VA considers the following evidence:
- Medical progress notes
- Credible lay evidence describing the frequency of symptoms, as long as a medical professional has verified the symptoms are related to migraine headaches
- Contemporaneous records, such as a headache journal
- Prescription refill records
- Witness statements
If a veteran keeps a headache journal, it can be accepted as credible lay testimony to document the following:
- Headache frequency
- Prostration
- Work-related limitations, such as the use of sick leave due to headaches
The M21-1 explains that while an individual’s description of their symptoms is important, medical evidence is required to confirm that the reported symptoms are caused by service-connected migraine headaches.
For example, the M21-1 provides this scenario: A claimant reports experiencing severe headaches and vomiting when exposed to light. During these episodes, they are unable to perform any activities and must rest or sleep. If medical evidence supports that these symptoms are caused by migraine headaches, it can be determined that the headaches result in prostration.
You can read the M21-1 Adjudication Procedures Manual regarding 8100 Migraine here.
Further Learning
Migraines can severely affect a person’s quality of life and, for veterans, may be linked to their military service. This link can make migraines eligible for a service-connected disability rating through the VA. This article explains the basics of migraines, the C&P exam process, and how the VA assigns disability ratings for migraines.
If you are a veteran suffering from migraines, register with Valor 4 Vet to get a nexus letter or complete the online DBQ for migraine headaches today.
References
1. Marmura, M., Silberstein, S., & Schwedt, T. (2015). The acute treatment of migraine in adults: the american headache society evidence assessment of migraine pharmacotherapies. Headache the Journal of Head and Face Pain, 55(1), 3-20. https://doi.org/10.1111/head.12499
2. Silberstein, S., Cohen, J., Seminerio, M., Yang, R., Ashina, S., & Katsarava, Z. (2020). The impact of fremanezumab on medication overuse in patients with chronic migraine: subgroup analysis of the halo cm study. The Journal of Headache and Pain, 21(1). https://doi.org/10.1186/s10194-020-01173-8
3. Arasalingam, A. and Gunatilake, S. (2013). Preventive pharmacologic treatment of migraine in adults. Sri Lanka Journal of Neurology, 2(1), 11-16. https://doi.org/10.4038/sljon.v2i1.100
4. Bigal, M., Rapoport, A., Sheftell, F., Tepper, S., & Lipton, R. (2007). The international classification of headache disorders revised criteria for chronic migraine—field testing in a headache specialty clinic. Cephalalgia, 27(3), 230-234. https://doi.org/10.1111/j.1468-2982.2006.01274.x
5. Liaquat, A., Sheikh, W., Yousaf, I., Mumtaz, H., Zafar, M., & Sherwani, A. (2023). Frequency of migraine and its associated triggers and relievers among medical students of lahore: a cross-sectional study. Annals of Medicine and Surgery, 86(1), 103-108. https://doi.org/10.1097/ms9.0000000000001377
6. Rashid, S. and Rahman, S. (2023). Preventing and controlling an acute attack of migraine during the fasting month of ramadan – an islamic and scientific perspective from prophetic medicine. Bangladesh Journal of Medical Science, 22(2), 280-283. https://doi.org/10.3329/bjms.v22i2.64985
7. Yuan, H., Spare, N., & Silberstein, S. (2019). Targeting cgrp for the prevention of migraine and cluster headache: a narrative review. Headache the Journal of Head and Face Pain, 59(S2), 20-32. https://doi.org/10.1111/head.13583
8. Wells, R., Bertisch, S., Buettner, C., Phillips, R., & McCarthy, E. (2011). Complementary and alternative medicine use among adults with migraines/severe headaches. Headache the Journal of Head and Face Pain, 51(7), 1087-1097. https://doi.org/10.1111/j.1526-4610.2011.01917.x
9. Evers, S., Frese, A., Summ, O., Husstedt, I., & Marziniak, M. (2022). Levetiracetam in the prophylactic treatment of episodic migraine: a prospective open label study. Cephalalgia, 42(11-12), 1218-1224. https://doi.org/10.1177/03331024221103815
10. Ishii, M., Onaya, T., Katoh, H., Kiuchi, Y., Kasai, H., Kawamura, M., … & Shimizu, S. (2012). Association between theg252atumor necrosis factor-β gene polymorphism and medication-overuse headache. Journal of Clinical Neurology, 8(4), 301. https://doi.org/10.3988/jcn.2012.8.4.301
11. Dindo, L., Recober, A., Haddad, R., & Calarge, C. (2016). Comorbidity of migraine, major depressive disorder, and generalized anxiety disorder in adolescents and young adults. International Journal of Behavioral Medicine, 24(4), 528-534. https://doi.org/10.1007/s12529-016-9620-5
12. Diest, A., Ernst, M., Slater, S., & Powers, S. (2017). Similarities and differences between migraine in children and adults: presentation, disability, and response to treatment. Current Pain and Headache Reports, 21(12). https://doi.org/10.1007/s11916-017-0648-2
13. Tency, N., Roy, A., Krishnakumaran, N., & Thomas, A. (2023). Unraveling abdominal migraine in adults: a comprehensive narrative review. Cureus. https://doi.org/10.7759/cureus.43760
