10 Most Common Secondary Conditions to Migraines (The Insider’s Guide)

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This is your Insider’s Guide to the 10 Most Common Secondary Conditions to Migraines for VA disability benefits.

Migraines are more than just painful headaches; they can cause or aggravate a variety of other serious conditions, including mental health disorders, neck pain, sleep disorders, and even gastrointestinal issues, among others.  

Understanding these secondary conditions is critical for maximizing your VA disability claim and ensuring you receive the rating and compensation you deserve for serving our country.

This high-value blog post will walk you through 10 VA disabilities that are commonly caused or aggravated by your service-connected migraine headaches.

Let’s begin!

Summary of Key Points

• Migraine headaches can trigger or worsen secondary conditions such as vertigo, tinnitus, sleep disorders, and mental health conditions, among others, which are important to include in a VA disability claim to maximize your benefits.

• Understanding VA ratings for secondary conditions like vertigo, tinnitus, and sleep apnea is crucial, as they range from 10% to 100% based on the severity of symptoms, including prostrating attacks and the need for medical devices like CPAP machines.

• Mental health disorders such as depression and anxiety are common secondary conditions linked to migraines, and the VA rates them based on social and occupational impairment with ratings from 0% to 100%, depending on how they affect daily life.

• A Nexus Letter is mission critical for establishing secondary service connection, as it links the primary service-connected condition (like migraines) to the secondary conditions, strengthening your VA disability claim. This letter can serve as the linchpin for proving VA service connection.

Secondary Conditions to Migraines for VA Disability Benefits

#1. Vertigo Secondary to Migraines

Vestibular migraines often involve vertigo or dizziness, affecting a veteran’s balance and sense of spatial awareness. Many migraine sufferers experience vertigo either during or between migraine episodes. This connection is especially strong in cases of vestibular dysfunction, where both the inner ear and brain are impacted, causing balance issues and migraines to arise together.

VA ratings for vertigo secondary to migraines range from 10% to 100% with breaks at 30% and 60%. The highest schedular rating for vertigo is 100% and includes severe symptoms of hearing impairment with attacks of vertigo and cerebellar gait occurring more than once weekly, with or without Tinnitus.

What are the VA disability ratings for Vertigo?

The VA will select the Diagnostic Code (DC) under 38 CFR § 4.87 that most accurately describes your vertigo symptoms in terms of frequency, severity, and duration.

• Vertigo with dizziness and occasional staggering rate at 30%.

• Vertigo with occasional dizziness rate at 10%.

Note: Objective findings supporting the diagnosis of vestibular disequilibrium are required before a compensable evaluation can be assigned under this code. Hearing impairment or suppuration shall be separately rated and combined.

#2. Tinnitus Secondary to Migraines

Tinnitus, or ringing in the ears, is another well-documented secondary condition to migraines. Migraines can cause auditory disruptions, and those with vestibular migraines are especially prone to tinnitus. Studies suggest that people with migraines are twice as likely to suffer from tinnitus than those without migraines​.

The VA rates tinnitus secondary to migraines under 38 CFR § 4.87, Diagnostic Code (DC) 6260, Tinnitus, Recurrent. The only VA rating for tinnitus is 10%. There are no higher or lower ratings.

#3. Sleep Disorders (Including Sleep Apnea) Secondary to Migraines

Migraines are strongly linked to sleep disorders, such as insomnia and sleep apnea. The frequent pain and discomfort from migraines can make it difficult to get restful sleep, leading to conditions like chronic insomnia or worsening sleep apnea, which can further aggravate migraines.

The VA rates insomnia secondary to migraines as part of the General Rating Formula for Mental Disorders, under 38 CFR § 4.130. Insomnia itself is often secondary or a symptom to other ratable VA conditions such as migraines, PTSD, anxiety, or chronic pain. The VA assigns ratings based on the severity of social and occupational impairment caused by the condition due to your severity of symptoms:

• 0% Rating: Symptoms are present but do not significantly impair daily functioning or social and occupational life.

• 10% Rating: Mild symptoms causing some impairment, but still able to function adequately in social and occupational settings.

• 30% Rating: Occasional decrease in work efficiency with intermittent periods of inability to perform tasks, but generally functioning satisfactorily.

• 50% Rating: Reduced reliability and productivity, with symptoms like difficulty understanding complex commands, impaired judgment, disturbances of motivation, or difficulty maintaining effective relationships.

• 70% Rating: Significant social and occupational impairment, with symptoms such as near-continuous panic or depression, impaired impulse control, difficulty in adapting to stressful circumstances, and inability to establish and maintain effective relationships.

• 100% Rating: Total occupational and social impairment due to severe symptoms, including gross impairment in thought processes, persistent danger to self or others, and inability to perform activities of daily living.

The VA rates sleep apnea secondary to migraines under 38 CFR § 4.97, Diagnostic Code 6847, based on the severity of the condition and the treatments required. Here are the rating criteria:

• 100% Rating: Assigned if sleep apnea causes chronic respiratory failure with carbon dioxide retention, the need for a tracheostomy, or requires the use of a ventilator.

• 50% Rating: Given if a veteran requires the use of a continuous positive airway pressure (CPAP) machine to manage obstructive sleep apnea.

• 30% Rating: If there is persistent daytime hypersomnolence (excessive daytime sleepiness), even without the use of a CPAP machine.

• 0% Rating: Sleep apnea is diagnosed but does not cause significant symptoms or require specific treatments such as a CPAP machine.

To receive a VA rating for sleep apnea, a veteran typically needs to undergo a sleep study to confirm the diagnosis. Veterans must also establish service connection by proving that their sleep apnea either originated or was aggravated during military service, or that it is secondary to an already service-connected condition.

#4. Depression and Anxiety Secondary to Migraines

There is a well-established bi-directional relationship between migraines and mental health conditions like depression and anxiety. Migraine sufferers are more prone to develop these conditions due to the chronic stress and limitations imposed by the migraines. Conversely, mental health issues can trigger or worsen migraines, making it an ongoing cycle of discomfort.

The VA rates depression and anxiety secondary to migraines under the General Rating Formula for Mental Disorders, under 38 CFR § 4.130 via multiple Diagnostic Codes. This formula is based on the level of social and occupational impairment caused by depression. VA ratings for depression and anxiety range from 0% to 100%, depending on the severity of symptoms and their impact on your work, life, and social functioning. Here are the rating levels:

• 0% Rating: Symptoms are present but do not interfere significantly with daily functioning or require continuous medication. The veteran may not experience social or occupational impairment.

• 10% Rating: Mild or transient symptoms that decrease work efficiency only during periods of significant stress, or symptoms that are controlled by continuous medication.

• 30% Rating: Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily. Symptoms may include depressed mood, anxiety, panic attacks (weekly or less), chronic sleep impairment, or mild memory loss.

• 50% Rating: Reduced reliability and productivity, with symptoms like flattened affect, difficulty understanding complex commands, impaired judgment, disturbances of motivation and mood, or difficulty establishing and maintaining effective relationships.

• 70% Rating: Occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. Symptoms include suicidal ideation, obsessional rituals that interfere with routine activities, impaired impulse control, and near-continuous panic or depression affecting the ability to function independently.

• 100% Rating: Total occupational and social impairment, due to symptoms like gross impairment in thought processes, persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting self or others, and inability to perform activities of daily living.

The VA assigns a rating based on the severity of symptoms and their impact on the veteran’s daily life and work. To receive a rating for depression, the veteran must provide medical evidence of the diagnosis and its connection to military service, either directly or as a secondary condition​.

#5. Fibromyalgia and Chronic Pain Syndrome Secondary to Migraines

Migraines are often part of a larger pain spectrum disorder, such as fibromyalgia or chronic pain syndrome. These conditions cause heightened sensitivity to pain, which can be exacerbated by migraines. Veterans with chronic migraines often experience widespread pain and fatigue, making daily functioning more difficult.

The VA ratings for fibromyalgia secondary to migraines and chronic pain syndrome (somatic symptom disorder) secondary to migraines are outlined under Diagnostic Code 5025 in the 38 CFR § 4.71a, Schedule of Ratings for the Musculoskeletal System and in the General Rating Formula for Mental Health Conditions under 38 CFR § 4.130 via Diagnostic Code 9421.

Fibromyalgia is rated based on the frequency and severity of widespread musculoskeletal pain and other symptoms like fatigue, sleep disturbances, and headaches. The VA assigns the following ratings under Diagnostic Code 5025:

• 40% Rating: For symptoms that are constant or nearly so and refractory to treatment. This is the highest possible rating for fibromyalgia, meaning the condition is so severe that it affects the veteran continuously and doesn’t respond well to treatments.

• 20% Rating: For symptoms that are episodic, with exacerbations often triggered by environmental or emotional stress or by overexertion, and which occur more than one-third of the time.

• 10% Rating: For symptoms that require continuous medication for control or occur only occasionally.

Fibromyalgia is also considered a presumptive condition for veterans who served in the Gulf War and can be connected to service without the need for specific in-service documentation of the condition.

The VA assigns ratings for somatic symptom disorder under the General Rating Formula for Mental Disorders, under 38 CFR § 4.130 based on how the condition impacts a veteran’s social and occupational functioning. Here’s a detailed explanation of the rating levels:

• 0% Rating: Symptoms are present but do not interfere significantly with daily functioning or require continuous medication. The veteran may not experience social or occupational impairment.

• 10% Rating: Mild or transient symptoms that decrease work efficiency only during periods of significant stress, or symptoms that are controlled by continuous medication.

• 30% Rating: Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily. Symptoms may include depressed mood, anxiety, panic attacks (weekly or less), chronic sleep impairment, or mild memory loss.

• 50% Rating: Reduced reliability and productivity, with symptoms like flattened affect, difficulty understanding complex commands, impaired judgment, disturbances of motivation and mood, or difficulty establishing and maintaining effective relationships.

• 70% Rating: Occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. Symptoms include suicidal ideation, obsessional rituals that interfere with routine activities, impaired impulse control, and near-continuous panic or depression affecting the ability to function independently.

• 100% Rating: Total occupational and social impairment, due to symptoms like gross impairment in thought processes, persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting self or others, and inability to perform activities of daily living.

In summary, the VA rates somatic symptom disorder by evaluating the severity of the condition’s impact on a veteran’s ability to work and interact socially. Each rating level reflects the extent of impairment caused by the disorder and the corresponding compensation level.

#6. Cervical Strain (Neck Pain) Secondary to Migraines

Migraines frequently co-occur with cervical strain, or neck pain. This condition, often referred to as cervicogenic headaches, arises when the tension or injury in the neck triggers migraines. Veterans who have suffered neck or spinal injuries may develop migraines as a secondary condition due to the strain on the muscles and nerves in the neck.

The VA rates lumbosacral or cervical strain secondary to migraines, under 38 CFR § 4.71a Diagnostic Code 5237.

VA Ratings for Neck Pain range from 10 percent to 100 percent, with breaks at 20 percent, 30 percent, 40 percent, and 50 percent. The highest scheduler rating for neck pain is 100 percent, which means your entire spine is frozen in an unfavorable position.

Pro Tip: In accordance with the “Painful Motion” principle, if you have pain upon flexion or extension of your neck, the VA is required to award the minimum compensable rating for the condition, which is 10 percent.

#7. TMJ Disorders Secondary to Migraines Secondary to Migraines

Temporomandibular joint (TMJ) disorders are often linked to migraines due to the muscle tension experienced during migraine attacks. TMJ problems can cause pain and difficulty in moving the jaw, and the associated tension can trigger or worsen migraine episodes.

The VA rates Temporomandibular Joint (TMJ) disorders secondary to migraines under Diagnostic Code 9905, which is part of the 38 CFR § 4.150, Schedule of Ratings for Dental and Oral Conditions. TMJ disorders affect the movement and function of the jaw and can cause pain, limited motion, and difficulty chewing. Here’s how the VA rates TMJ disorder, based on the range of motion of the temporomandibular joint:

• A 10% rating is assigned when the inter-incisal range (the distance the mouth can open between the upper and lower incisors) is limited to 31 to 40 millimeters, or there is lateral excursion (side-to-side jaw movement) of 0 to 4 millimeters.

• A 20% rating is given when the inter-incisal range is limited to 21 to 30 millimeters.

• A 30% rating is assigned if the inter-incisal range is limited to 11 to 20 millimeters.

• A 40% rating (the highest possible for TMJ) is given when the inter-incisal range is limited to 0 to 10 millimeters, indicating severe restriction of jaw movement.

Other Considerations:

• Pain and Functional Loss: In addition to the measured range of motion, the VA also considers the impact of pain, weakness, fatigue, and incoordination on the veteran’s functional ability.

• Arthritis: If arthritis is a factor in the TMJ condition, it can also be rated under the criteria for degenerative arthritis.

The VA assigns these ratings based on the severity of the symptoms and how much they limit the veteran’s ability to open their mouth or perform daily activities like chewing and speaking.

#8. Cognitive Impairment (“Brain Fog”) Secondary to Migraines

Cognitive issues or “brain fog” are common among migraine sufferers, especially those with frequent or severe attacks. Veterans may experience difficulties in memory, concentration, and executive function, often worsening during or after a migraine attack. This cognitive impairment can severely impact daily tasks and work performance.

The VA rates cognitive impairment secondary to migraines, commonly referred to as “brain fog”, under the General Rating Formula for Mental Disorders, 38 CFR § 4.130. Cognitive impairment can be associated with conditions like traumatic brain injury (TBI), PTSD, depression, or other mental health disorders. The VA assigns a rating based on how much the cognitive issues impact a veteran’s ability to function socially and occupationally due to their severity of mental health symptoms:

• 0% Rating: Symptoms are present but do not interfere significantly with daily functioning or require continuous medication. The veteran may not experience social or occupational impairment.

• 10% Rating: Mild or transient symptoms that decrease work efficiency only during periods of significant stress, or symptoms that are controlled by continuous medication.

• 30% Rating: Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily. Symptoms may include depressed mood, anxiety, panic attacks (weekly or less), chronic sleep impairment, or mild memory loss.

• 50% Rating: Reduced reliability and productivity, with symptoms like flattened affect, difficulty understanding complex commands, impaired judgment, disturbances of motivation and mood, or difficulty establishing and maintaining effective relationships.

• 70% Rating: Occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. Symptoms include suicidal ideation, obsessional rituals that interfere with routine activities, impaired impulse control, and near-continuous panic or depression affecting the ability to function independently.

• 100% Rating: Total occupational and social impairment, due to symptoms like gross impairment in thought processes, persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting self or others, and inability to perform activities of daily living.

Additional Considerations:

• Cognitive impairment from TBI: If cognitive impairment results from a traumatic brain injury (TBI), it may be rated specifically under Diagnostic Code 8045, which provides separate criteria for TBI-related cognitive deficits like memory loss, decision-making issues, and executive dysfunction.

• Comorbid mental health conditions: Cognitive impairment is often linked with PTSD, depression, or anxiety, and may be rated alongside these conditions, using the General Rating Formula for Mental Disorders.

The VA assesses cognitive impairment using the veteran’s medical history, psychiatric evaluations, and, if applicable, neuropsychological testing to determine the appropriate rating level.

#9. Gastroesophageal Reflux Disease (GERD) Secondary to Migraines

The medications often used to treat migraines, especially NSAIDs, can lead to GERD or worsen existing gastrointestinal issues. Migraines themselves may also contribute to GI symptoms, such as nausea, vomiting, or acid reflux, making GERD a potential secondary condition for veterans suffering from frequent migraines.

Historically, the VA rated GERD analogous to Hiatal Hernia, DC 7346, with ratings of 10%, 30%, or 60%. But with the new digestive systems VA rating changes, GERD secondary to migraines is rated under 38 CFR § 4.114, Diagnostic Code 7206, with VA ratings of either 0%, 10%, 30%, 50%, or 80%. Note: GERD and Acid Reflux are both rated under DC 7206, which is a new DC and rating criteria beginning May 19, 2024.

What are the new VA ratings for GERD?

• 80% VA Rating for GERD: Documented history of recurrent or refractory esophageal stricture(s) causing dysphagia with at least one of the symptoms present: (1) aspiration, (2) undernutrition, and/or (3) substantial weight loss as defined by § 4.112(a) and treatment with either surgical correction of esophageal stricture(s)  or percutaneous esophago-gastrointestinal tube (PEG tube).  

• 50% VA Rating for GERD: Documented history of recurrent or refractory esophageal stricture(s) causing dysphagia which requires at least one of the following (1) dilatation 3 or more times per year, (2) dilatation using steroids at least one time per year, or (3) esophageal stent placement.

• 30% VA Rating for GERD: Documented history of recurrent esophageal stricture(s) causing dysphagia which requires dilatation no more than 2 times per year.

• 10% VA Rating for GERD: Documented history of esophageal stricture(s) that requires daily medications to control dysphagia otherwise asymptomatic.

• 0% VA Rating for GERD: Documented history without daily symptoms or requirement for daily medications.  

#10. Hypersensitivity to Light and Sound (Photophobia and Phonophobia) Secondary to Migraines

Light and sound sensitivity, known as photophobia and phonophobia, are hallmark symptoms of migraines. These sensitivities can persist even outside of migraine episodes, causing ongoing discomfort. Over time, veterans with migraines may develop heightened responses to light and sound, disrupting their ability to function in normal environments.

The VA typically rates hypersensitivity to light (photophobia) and sound (phonophobia) secondary to migraines as part of a larger condition, such as a symptom of migraines or connected to traumatic brain injury (TBI), rather than assigning a separate diagnostic code for these symptoms. These symptoms are considered when determining the severity of the underlying condition and its impact on a veteran’s ability to function socially and occupationally.

Hypersensitivity to Light and Sound as Symptoms of Migraines:

Photophobia (light sensitivity) and phonophobia (sound sensitivity) are common symptoms of migraines and are evaluated under 38 CFR § 4.124a, Diagnostic Code 8100 for migraines. The VA rates migraines based on the frequency and severity of “prostrating attacks” (severe migraine episodes that require a person to stop all activities and lie down):

• 0% Rating: Migraines are diagnosed, but attacks are infrequent or cause minimal impairment.

• 10% Rating: Veteran experiences prostrating attacks averaging one episode every two months.

• 30% Rating: Veteran has prostrating attacks occurring once a month.

• 50% Rating: Veteran has very frequent, completely prostrating, and prolonged attacks that are productive of severe economic inadaptability.

If photophobia and phonophobia significantly affect the veteran’s ability to work or perform daily activities, they are factored into the overall rating for migraines.

Hypersensitivity to Light and Sound in Traumatic Brain Injury (TBI):

When photophobia and phonophobia result from a traumatic brain injury (TBI), they may be rated by the VA. The VA rates Traumatic Brain Injury (TBI) under Diagnostic Code 8045 in 38 CFR § 4.124a. The ratings are based on the severity of residual cognitive, emotional, behavioral, or physical symptoms caused by the TBI. The VA uses three main categories to evaluate TBI residuals: cognitive impairments, emotional/behavioral dysfunction, and physical symptoms. Each category is evaluated separately, and the rating is based on the level of impairment caused by the TBI. Below are the VA ratings for TBI:

• 0% Rating: No significant residuals of TBI are present. Symptoms may be present but do not impact daily functioning, or they are well-managed and controlled with treatment.

• 10% Rating: Veteran experiences mild symptoms that cause occasional issues with memory, concentration, or headaches, but they are controlled well with treatment and do not severely limit daily activities or work efficiency.

• 40% Rating: Veteran experiences moderate impairment due to TBI. There may be noticeable memory, concentration, and attention issues, alongside symptoms like headaches, dizziness, and light sensitivity. The veteran may experience reduced reliability in completing tasks, but can still function in most situations with some limitations.

• 70% Rating: Severe symptoms are present, significantly impairing cognitive abilities, emotional control, and physical coordination. Veterans at this level may experience major problems with decision-making, frequent headaches, irritability, or inability to manage stress, and these symptoms may impair their ability to work and maintain relationships.

• 100% Rating: The highest rating is given for veterans with total occupational and social impairment due to TBI. Symptoms can include severe memory loss, confusion, inability to perform tasks, persistent headaches, and other cognitive deficits. This level of impairment makes it impossible for the veteran to work or function in most environments.

Comorbid Conditions:

In some cases, photophobia and phonophobia may also be linked to other conditions, such as post-concussive syndrome, PTSD, or anxiety, and are factored into the ratings for those conditions. For example, if a veteran has PTSD and suffers from heightened sensitivity to stimuli like light and sound, these symptoms may be considered when assigning a rating under the mental health rating criteria (38 CFR § 4.130).

Conclusion:

The VA does not assign a standalone rating for hypersensitivity to light and sound but includes these symptoms in the ratings for underlying conditions like migraines or TBI. Veterans experiencing these symptoms should ensure they are properly documented as part of their overall disability claim.

Pro Tip: The Importance of a Nexus Letter for Secondary Conditions

A nexus letter is one of the most critical pieces of evidence when filing a VA claim for a secondary condition.

It serves as the medical link or connection between your primary service-connected condition and the new condition you’re claiming.

The VA won’t simply assume your secondary condition is related, so a detailed nexus letter from a qualified doctor is essential.

In the nexus letter for a secondary condition, your doctor should clearly explain how your secondary condition (e.g., sleep apnea or tinnitus) is “proximately due to” or “aggravated by” the primary condition (e.g., migraines).

The doctor should use certain nexus language, stating that it is “at least as likely as not” that the primary condition is responsible for the secondary one.

Without this, the VA might reject your claim due to a lack of medical evidence linking the two conditions.

A well-written nexus letter significantly strengthens your claim and can be the linchpin between VA claim approval and denial.

Looking for a Nexus Letter for Conditions Secondary to Migraines?

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