Migraines Secondary to PTSD

If your PTSD is service connected and a doctor has diagnosed you with migraines, you can claim the migraines as secondary to the PTSD. The research supports the question. The hard part is showing, with your own records, how the two are linked in you, and answering both questions VA asks: did the PTSD cause the migraines, and did it make them worse. This page covers what the research says, how VA decides and rates the claim, what the headaches DBQ covers, and what the nexus letter needs.

Can PTSD cause migraines?

The research shows a consistent link. It does not settle which condition comes first, and a careful opinion says so.

• A 2026 systematic review of 11 studies from five countries (Nitsche and colleagues, Headache) found migraine in 6.5% to 46.5% of people with PTSD, against 1.4% to 25.8% of people without it. Every study it included reported a positive association, and the groups studied included military personnel.
• A study of 33,327 women in the Nurses' Health Study II (Crowe and colleagues, Epidemiology and Psychiatric Sciences, 2024) found that PTSD, but not trauma without PTSD, was tied to new migraine later (adjusted relative risk 1.20). Migraine was also tied to later PTSD (1.26), so the link ran in both directions.
• Among veterans with a headache disorder in a VA primary care network, PTSD was the most frequent psychiatric condition alongside it (Ramon and colleagues, Behavioral Medicine, 2024).
• PTSD may also make existing migraine worse. In a national U.S. survey, people with both conditions reported more than two and a half times as many days of reduced work quality as people with migraine alone (Rao and colleagues, Headache, 2015). In a pilot study of 60 headache patients, PTSD was far more common with chronic migraine (42.9%) than with episodic migraine (9.4%), which the authors said suggests PTSD may be a risk factor for migraine becoming chronic, pending longer studies (Peterlin and colleagues, Headache, 2008).

Why it happens is not settled. A 2011 review in Headache (Peterlin and colleagues) says PTSD may substantially increase the disability that migraine causes, and discusses possible mechanisms without settling them. The path medical opinions most often have to weigh is sleep. In a Norwegian study of 15,268 adults who had no headaches at the start, insomnia was tied to a 40 percent higher risk of headache 11 years later, with similar results for migraine. Among people whose insomnia kept them from working, the risk of migraine was twice as high (Ødegård and colleagues, Headache, 2011). That study was not about PTSD, so if your PTSD exam or therapy notes document poor sleep, a doctor has to connect the two in your case.

Not every finding points one way. A study of 4,680 male twins from the Vietnam Era Twin Registry found that shared genes and shared environment explain part of the overlap between PTSD and migraine (Gasperi and colleagues, Psychosomatic Medicine, 2021). A 2026 genetic study of more than 433,000 veterans in the Million Veteran Program found high genetic correlation between migraine and PTSD, but its genetic tests for cause and effect found no causal link (Gasperi and colleagues, Molecular Psychiatry). And among more than 1.1 million Israeli recruits, headache before enlistment predicted later combat-related PTSD (Roitman and colleagues, Social Psychiatry and Psychiatric Epidemiology, 2026). An association that runs both ways cannot tell VA which condition came first in your life. The opinion has to rely on your timeline, and if your headaches came first, on aggravation.

How VA decides migraines secondary to PTSD

Secondary service connection is in 38 CFR § 3.310. VA grants it in two ways:

• Caused by. Your service-connected PTSD caused the migraines, at least as likely as not.
• Aggravated by. Your migraines are aggravated by your service-connected PTSD, meaning they would be less severe but for the PTSD (M21-1 V.ii.2.D). VA rates only the part above the baseline, so the opinion should describe the baseline.

The claim needs three things in the file: a current migraine diagnosis, service-connected PTSD, and a medical opinion linking the two with reasoning. The same rules apply to other conditions claimed secondary to PTSD, such as sleep apnea secondary to PTSD.

If your headaches started before your PTSD

Then the claim is about aggravation. Under § 3.310(b), VA will not concede aggravation unless the baseline severity is shown by medical evidence created before the aggravation began, or by the earliest medical evidence created after it. Keep your older headache records, even if they complicate the story. They are what make the comparison possible.

PTSD treatment notes count

A note written during PTSD care can raise the secondary theory even when you filed on another one. In Board citation A25019873 (March 2025), a veteran claimed migraines from burn pit exposure, and a note from the veteran's PTSD care recorded new headache medication. The Board found VA had never developed the PTSD theory and ordered opinions on causation and aggravation that addressed the veteran's chronic sleep impairment from PTSD and an earlier examiner's note that lack of sleep can trigger migraines. Board decisions are not precedential, but they show what the Board looks for.

VA rating for migraines secondary to PTSD

Migraines secondary to PTSD are rated the same way as any migraines, under 38 CFR § 4.124a, Diagnostic Code 8100:

• 50%: very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability
• 30%: characteristic prostrating attacks occurring on an average once a month over last several months
• 10%: characteristic prostrating attacks averaging one in 2 months over last several months
• 0%: less frequent attacks

There is nothing above 50 percent for migraines alone. The whole schedule turns on the word "prostrating." VA's headaches DBQ defines it, for VA purposes, as "causing extreme exhaustion, powerlessness, debilitation or incapacitation with substantial inability to engage in ordinary activities." A severe headache you can work through is not the same thing. The migraine VA rating page covers the line between 30 and 50 percent and what "severe economic inadaptability" means.

VA rates the migraines separately from the PTSD, because migraines have their own diagnostic code. The two ratings combine under 38 CFR § 4.25. A 50% PTSD rating and a 30% migraine rating combine to 65, which VA rounds to 70%. If VA grants the migraines on aggravation, the rating reflects only the part above your baseline.

The C&P exam for migraines secondary to PTSD

VA usually orders an exam or a medical opinion for this claim. The examiner is asked whether your migraines are at least as likely as not caused by your PTSD and, separately, whether the PTSD aggravated them. Both questions matter. An opinion that answers only the first one is inadequate under El-Amin v. Shinseki (2013).

In Board citation A25018791 (March 2025), the veteran had submitted the 2011 Peterlin review linking PTSD with greater headache-related disability in people with migraine. The VA examiner said PTSD did not cause the migraines and never addressed whether PTSD made them worse. The Board sent the claim back for a separate aggravation opinion that had to discuss the article.

What the examiner looks at:

• When your headaches started and how they changed, compared with your PTSD history and treatment
• Your PTSD exam findings and therapy notes on sleep
• Headache entries in your PTSD treatment records, and when medications were started or changed
• Other explanations, such as a head injury or a neck condition
• How often you have prostrating attacks and what you cannot do during one

Unfavorable opinions can go wrong in a few ways: they answer only causation, never reach the PTSD theory, or blame genetics without saying whether you have any such factors, which the Board found inadequate in A25019873. C&P exam prep can help you describe your attacks in the terms the exam uses. The Board section below shows how the Board handled VA opinions on this pair.

Why migraines secondary to PTSD claims get denied

These are the gaps that sink a claim like this:

• No diagnosis that separates migraine from other headache types. A description of "bad headaches" is not a diagnosis.
• The only medical opinion is a negative VA opinion, and nothing in the file answers it.
• The opinion addresses causation and never addresses aggravation.
• A private opinion states a conclusion with no reasoning, or ignores a head injury or other explanation in your records.
• Your headaches are documented before your PTSD, but the claim argues only that PTSD caused them.
• The record does not show how often prostrating attacks happen, so even a grant lands at a low rating.

The Board section below breaks down the evidence that decided the grants and the denials.

Nexus letter for migraines secondary to PTSD

A strong nexus letter for this claim does five things:

1. States that the doctor reviewed your records, including the migraine diagnosis, your PTSD treatment history, sleep findings and medication history.
2. Gives an opinion on causation: your migraines are at least as likely as not caused by your service-connected PTSD.
3. Gives a separate opinion on aggravation: your migraines are aggravated by your service-connected PTSD, meaning they would be less severe but for the PTSD, and describes the baseline from your earliest headache records.
4. Explains the reasoning in plain medical terms, ties it to your timeline, names the path it relies on (for example, sleep loss documented in your PTSD records), and cites the research, including what it does not settle, such as the two-way association and shared genetics.
5. Deals with other explanations in your file, such as a head injury or a neck condition, and says how they change the conclusion.

Questions to bring to the doctor:

• Is the migraine diagnosis supported, and when is it first documented?
• What in my history supports or weighs against PTSD, or sleep loss from PTSD, causing the migraines?
• If the migraines came first, which records show the baseline, and would they be less severe today but for the PTSD?
• What other explanations need to be addressed, and how do they change your conclusion?

A clinician may find the evidence insufficient or another cause more persuasive. Where these opinions break down at the Board is predictable: no rationale, a conclusion with no reasoning behind it, an incomplete review of the records, or a specialty that does not fit the question. Raven Nexus pulls the key passages from your records and the research into an organized draft your doctor can review.

The headaches DBQ for migraines secondary to PTSD

There is no separate DBQ for migraines secondary to PTSD. VA's public Headaches (including Migraine Headaches) Disability Benefits Questionnaire, updated July 9, 2024, documents the migraines themselves:

• The diagnosis, its history and course, and any continuous medication
• Symptoms such as nausea, sensitivity to light or sound and vision changes, and how long typical head pain lasts
• Whether you have characteristic prostrating attacks, and how often, from less often than once in two months to more than once a month
• Whether you have completely prostrating and prolonged attacks, and how often
• Whether the headaches affect your ability to work, with examples

The DBQ does not ask what caused the migraines. It measures severity for the rating. The link to PTSD comes from a medical opinion: the VA examiner's, or a private nexus letter you submit with the DBQ. Your own doctor can fill out the form, and VA may still order its own exam. Ask the doctor to answer the attack questions from a headache log and to give real examples of the work impact. Statements from a spouse or coworker who has seen your attacks can back up the frequency (buddy letters).

Questions veterans ask about migraines secondary to PTSD

Can migraines be secondary to PTSD?

Yes. VA can grant migraines secondary to PTSD under 38 CFR § 3.310 when PTSD caused them or made them worse. Research finds migraine more common in people with PTSD, but a medical opinion has to apply that research to your own records.

What is the VA rating for migraines secondary to PTSD?

The same as any migraines under Diagnostic Code 8100: 0, 10, 30 or 50 percent, based on how often prostrating attacks happen. The migraine rating then combines with your PTSD rating; for example, 50 percent PTSD and 30 percent migraines combine to 70 percent.

Is there a DBQ for migraines secondary to PTSD?

Not a separate one. The headaches DBQ documents the diagnosis, prostrating attacks and work impact, and the link to PTSD comes from a medical opinion.

What if I had headaches before my PTSD?

Then the claim is about aggravation. Your earliest headache records set the baseline, and the opinion has to say your migraines would be less severe but for the PTSD.

Does sleep loss from PTSD count as a link to migraines?

It can be part of the path. In a March 2025 decision the Board told the examiner to address chronic sleep impairment from PTSD and a note that lack of sleep can trigger migraines, but a doctor still has to explain the link in your case.

Sources

• 38 CFR § 3.310, secondary service connection; M21-1 V.ii.2.D, aggravation of a nonservice-connected disability by a service-connected one.
• 38 CFR § 4.124a, Diagnostic Code 8100, migraine; 38 CFR § 4.25, combined ratings table.
• El-Amin v. Shinseki, 26 Vet. App. 136 (2013), an opinion must address aggravation.
• VA Headaches (including Migraine Headaches) Disability Benefits Questionnaire, updated July 9, 2024.
• Nitsche L, Helbach J, Stubenrauch S, Lakeberg M, Bantel C, Hoffmann F. The association between posttraumatic stress disorder and migraine: A systematic review. Headache. 2026;66(4):963-975. PMID 41705319.
• Crowe HM, Sampson L, Purdue-Smithe AC, Rexrode KM, Koenen KC, Rich-Edwards JW. Bidirectional analysis of the association between migraine and post-traumatic stress disorder in Nurses' Health Study II. Epidemiology and Psychiatric Sciences. 2024;33:e76. PMID 39658814.
• Ramon AE, Possemato K, Beehler GP. Headache Disorders in VHA Primary Care: Prevalence, Psychiatric Comorbidity, and Health Care Utilization. Behavioral Medicine. 2024;50(4):269-278. PMID 37712622.
• Rao AS, Scher AI, Vieira RV, Merikangas KR, Metti AL, Peterlin BL. The Impact of Post-Traumatic Stress Disorder on the Burden of Migraine: Results From the National Comorbidity Survey-Replication. Headache. 2015;55(10):1323-1341. PMID 26473981.
• Peterlin BL, Tietjen G, Meng S, Lidicker J, Bigal M. Post-traumatic stress disorder in episodic and chronic migraine. Headache. 2008;48(4):517-522. PMID 18377377.
• Peterlin BL, Nijjar SS, Tietjen GE. Post-traumatic stress disorder and migraine: epidemiology, sex differences, and potential mechanisms. Headache. 2011;51(6):860-868. PMID 21592096.
• Ødegård SS, Sand T, Engstrøm M, Stovner LJ, Zwart JA, Hagen K. The long-term effect of insomnia on primary headaches: a prospective population-based cohort study (HUNT-2 and HUNT-3). Headache. 2011;51(4):570-580. PMID 21457241.
• Gasperi M, Panizzon M, Goldberg J, Buchwald D, Afari N. Posttraumatic Stress Disorder and Chronic Pain Conditions in Men: A Twin Study. Psychosomatic Medicine. 2021;83(2):109-117. PMID 33337593.
• Gasperi M, Rosenthal SB, Maihofer AX, et al. A multi-ancestry meta genome-wide association study of migraine among veterans: associations with traumatic brain injury, depression, and post-traumatic stress disorder. Molecular Psychiatry. 2026;31(5):2660-2674. PMID 41420111.
• Roitman MS, Magiel E, Lichtenstein GR, et al. Headache as a predictive clinical marker for combat-related PTSD risk. Social Psychiatry and Psychiatric Epidemiology. 2026. PMID 42223652.
• Board of Veterans' Appeals citations A25018791 and A25019873 (both remanded). Board decisions are not precedential.
• Board figures on this page: Claim Raven's read of every Board decision from 2021 to 2026 that it holds, and of every decision since 1992 for the longer view.