Migraines can be service connected as secondary to PTSD when the evidence establishes that service-connected PTSD caused them or aggravated them. Having both diagnoses is not enough by itself.

There are also two separate questions in the claim: what connects the migraines to a service-connected condition, and how severe the migraine disability is. A detailed headache log may help with the second question without answering the first.

I would organize the evidence around those two questions before trying to assemble a particular set of medical phrases. That makes it easier to see what the record already explains and what still needs a clinician's assessment.

Causation and aggravation ask different questions

38 CFR § 3.310 covers disabilities caused or aggravated by service-connected disease or injury.

Causation asks whether PTSD caused the migraine condition. A medical assessment needs to connect the explanation to your history, rather than only noting that stress can accompany headaches.

Aggravation asks whether PTSD increased the severity of an existing migraine condition beyond its natural progression. Migraines that began before PTSD are not automatically excluded from consideration on that basis. The medical question is what worsened, why it worsened and whether the service-connected condition contributed to that increase.

The regulation includes a medical-evidence requirement for establishing the baseline level of severity in an aggravation claim. It describes evidence from before aggravation or the earliest medical evidence between the onset of aggravation and the evidence establishing current severity. Earlier treatment notes can therefore matter even when the current symptoms are well documented.

Do not treat these as interchangeable labels. An opinion that discusses whether PTSD caused migraines may leave the aggravation question unanswered. Whether either theory fits is a question for the evidence in the individual case.

PTSD, headache disorders, sleep problems and injury histories can overlap. That makes the relationship worth examining, but it does not establish a single cause for every veteran's migraines.

For example, a 2009 study of 308 returning veterans found associations between PTSD, combat injury and self-reported headache. It also found differences between headache groups: migraine alone was more closely associated with combat injury, while combined migraine and tension-type headache showed a different PTSD pattern. It was an observational study, not a test proving that PTSD caused a particular person's migraines.

A clinician may consider published research alongside the timing of your symptoms, treatment history, head injuries, other diagnoses and medication history. The useful part of an opinion is how it explains your case, including plausible alternative causes. Attaching a study without that explanation does not make its findings specific to you.

This article does not assign a grant rate to migraines secondary to PTSD. Outcomes for migraines attributed to a neck condition would be a different comparison and cannot supply that number.

Build a timeline that a clinician can evaluate

The timeline should help someone follow what happened before and after the relevant changes. It does not need to tell a tidier story than the records support.

Useful material may include:

  • Records establishing the migraine diagnosis and the service-connected PTSD condition.
  • The earliest headache complaints you can identify, including symptoms documented before a formal diagnosis.
  • Changes in attack frequency, duration or functional effects over time.
  • PTSD treatment records, medication changes and sleep history that a clinician considers relevant.
  • Records of head or neck injuries and other possible explanations for the headaches.
  • An opinion addressing causation, aggravation or both, with the reasoning and records behind the conclusion.

If a head injury is part of the history, include it. A claim should reflect the medically supported explanation rather than force every headache into a PTSD theory. Multiple relevant conditions can make the opinion more complicated; omitting one does not make the remaining explanation stronger.

VA's evidence guidance for secondary claims explains that the evidence must show a link between the new disability and a service-connected disability. Our nexus-letter explainer describes what a medical opinion is intended to contribute.

Migraine ratings depend on the attacks and their effects

Once service connection is established, migraine severity is evaluated under 38 CFR § 4.124a, Diagnostic Code 8100. The schedule provides these levels:

RatingCriterion in plain language
0%Attacks occur less frequently than the compensable criteria describe.
10%Characteristic prostrating attacks average one in two months over the last several months.
30%Characteristic prostrating attacks average once a month over the last several months.
50%Very frequent, completely prostrating and prolonged attacks productive of severe economic inadaptability.

The terms at 50% are part of the actual rating standard. A count of headache days alone does not answer all of them. Duration, the extent of incapacity and economic effects matter too.

In ordinary descriptions, explain what an attack prevents you from doing. Can you continue your usual activities? Do you need to stop, lie down or avoid light and sound? How long does that interruption last? What happens at work or when you are responsible for tasks at home?

The record should reflect your actual experience, including less severe attacks and periods when treatment helps. Repeating the word “prostrating” is less informative than explaining what happens during an attack.

A headache log can make the pattern easier to see

A useful log records dates, approximate duration, symptoms, treatment and the effect on ordinary activities. If an attack interrupted work, note what happened: missed hours, a task someone else completed, an unscheduled break or another specific effect.

Consider this fictional example:

September 3: Headache began around 10 a.m. with nausea and light sensitivity. I stopped working at 10:30, took my prescribed medication and rested in a dark room. I could resume ordinary activity around 3 p.m. I missed the afternoon meeting.

That entry gives a clinician or reviewer something concrete to assess. It does not establish a rating by itself. Use approximate times when that is all you know, and distinguish notes made during an attack from a later recollection.

Treatment records, workplace records and observations from someone who sees the attacks may provide additional context. A log helps describe severity; it does not independently prove that PTSD caused or aggravated the condition.

A migraine rating combines with other ratings

VA uses the combined ratings table in § 4.25, rather than ordinary addition. For a simple example with only two ratings:

  • 70% PTSD and 30% migraines combine to 79%, which rounds to 80%.
  • 70% PTSD and 50% migraines combine to 85%, which rounds to 90%.

Those are illustrations, not forecasts. Additional disabilities, the bilateral factor when applicable and the details of an aggravation award can change the calculation. The compensation amount depends on the final combined rating and other applicable factors, not on adding the standalone payment for migraines to an existing payment.

For the rating criteria and related evidence, the current migraine condition guide is the relevant reference.

Start by identifying the unanswered question

If the record already establishes migraines but does not explain their relationship to PTSD, more descriptions of painful attacks may leave the main gap untouched. If the relationship is supported but the attack pattern is unclear, the next useful work may be documenting severity.

Write down which question is missing an answer, then discuss it with the appropriate clinician or an accredited representative. That is more useful than assuming a diagnosis, a research paper and a log all establish the same thing.

Sources and scope

The legal and rating discussion was checked against the eCFR text current through September 14, 2026, including §§ 3.310, 4.124a and 4.25, and VA's evidence guidance. The cited observational study provides background only; it does not establish causation for an individual, a prevalence estimate for all veterans with PTSD or a VA approval probability.

I'm Landon, founder of Claim Raven and an Army veteran. Claim Raven sells claim-preparation tools. This article explains evidence questions; it does not diagnose the cause of headaches or provide legal advice about a particular claim.

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