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Migraines and bad headaches

Migraines and severe headaches

What it is

Migraines are bad headaches that come in attacks, often with sick stomach or trouble with light and sound.

VA's code numbers for this: 8100

What the examiner will do

Who does it: A VA doctor or a VA contract examiner. VA's exam page (updated Aug 15, 2025) names four contract companies: Loyal Source Government Services, OptumServe Health Services, Leidos QTC Health Services, and Veterans Evaluation Services (VES). (LHI is an older name; it is now part of OptumServe.) You can't pick which one. Answer every call or letter about scheduling.

  • Usually a VA or contract doctor, NP, or PA. Often 20-40 minutes.
  • They ask: How often do you get headaches? How long do they last? Where is the pain? What else happens (nausea, light hurts, aura)? What do you do during an attack? What medicine do you take? How do they affect work?
  • They may do a short check of nerves (strength, reflexes, eyes). Results are often normal - that's expected with migraines.

Tests, in plain words

'Prostrating'
VA's manual (M21-1) explains it as an attack so bad it causes extreme exhaustion, powerlessness, or incapacity, with a big inability to do normal activities. In plain words: you have to stop and lie down.
'Completely prostrating'
Almost total inability to do anything during the attack.
'Severe economic inadaptability'
Serious harm to your ability to earn a living. Missed days, leaving early, lost jobs, or having to take a lower job count. The court said you don't have to be totally unable to work (Pierce v. Principi).
No lab test
There is no blood test or scan that rates migraines. Your log and records are the proof.

The examiner fills out a form called a DBQ. You can read it ahead of time: Headaches (including Migraines) DBQ (opens VA's site).

The rating levels, in plain words

VA picks the level that best matches how often and how badly the condition affects you.

  • 0%

    Attacks that make you stop and lie down happen less than once every 2 months.

    VA's exact words

    With less frequent attacks

    Rule: 38 CFR 4.124a, DC 8100

  • 10%

    About one attack every 2 months, over the last several months, that forces you to stop and lie down.

    VA's exact words

    With characteristic prostrating attacks averaging one in 2 months over last several months

    Rule: 38 CFR 4.124a, DC 8100

  • 30%

    About one attack a month, over the last several months, that forces you to stop and lie down.

    VA's exact words

    With characteristic prostrating attacks occurring on an average once a month over last several months

    Rule: 38 CFR 4.124a, DC 8100

  • 50%

    Very frequent attacks that knock you out completely and last a long time, and are able to cause serious money and job problems (like lots of missed work, lost jobs, or cutting your hours). You do NOT have to be fully unable to work.

    VA's exact words

    With very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability

    Rule: 38 CFR 4.124a, DC 8100

What to track before your exam

What to write down: Every headache attack: date, how long, how bad, whether you had to lie down, medicine taken, and work missed.

How: Keep a headache log for at least 3 months (VA looks at 'the last several months'). Use paper or a phone app. Write it the same day. Ask your spouse to write a statement about what they see during attacks. Keep proof of missed work (time-off records, pay stubs, emails).

Your log: what to write each time

  1. Date
  2. Start time
  3. End time (or hours)
  4. Pain 0-10
  5. Had to stop and lie down? (Y/N)
  6. How long lying down
  7. Nausea / vomiting / light or sound bother?
  8. Medicine taken and did it help?
  9. Missed work or left early? (hours)
  10. Who saw it

Tap Print this page to get a blank log sheet and your exam-day checklist on paper.

Exam-day checklist

Tick each one off. Nothing you tick is saved or sent anywhere.

What to bring: Bring a photo ID, your list of medicines and doses, your home log, and any new private records you have not sent to VA yet. VA says you don't have to bring anything, but your notes help you remember. A spouse or caregiver may come along. VA says you can ask the examiner if they can stay in the room. The examiner may ask them to wait outside.

Tell the examiner

Honest exam rules

  • Tell the whole truth. Don't add to it. Don't shrink it.
  • Describe a normal day AND your worst days. Say how often the worst days happen.
  • Answer the question you were asked. Skip the habit of saying 'I'm fine' or 'it's not that bad' when it is.
  • It's OK to read from your log or notes. Hand the examiner a copy if they will take it.
  • Don't act out symptoms or guess at numbers. If you don't know or can't remember, say so.
  • If something hurts or makes you worse during the exam, say so right then.
  • Fraud warning: knowingly giving VA false information is a federal crime (18 U.S.C. 1001) and can cost you all your benefits (38 U.S.C. 6103). Honest, complete answers protect you.
  • Count only attacks that really made you stop and lie down as 'prostrating.' Mention milder headaches separately.

Common mistakes

  • No headache log. Without dates, raters can't count frequency.

    Where this comes from: Headaches DBQ asks for frequency of prostrating attacks; secondary sources note Board accepts contemporaneous headache journals as lay evidence

  • Rater denies 50% because you still work. You don't have to be unable to work.

    Where this comes from: Pierce v. Principi, 18 Vet. App. 440 (2004)

  • Medical records never say 'prostrating.' The word isn't required; describe what happens.

    Where this comes from: M21-1 definition (as quoted in Board decisions; secondary). Verify current M21-1 text on KnowVA.

  • Saying '1-2 a month' when the log shows more, or the other way around. Match your log.

    Where this comes from: HTB practice note

Questions to ask together

A spouse, grown child or friend can read these out loud. Talk about each one before the exam, so nothing gets left out.

  1. How many headaches this month made you stop what you were doing and lie down?
  2. How long did you have to lie down?
  3. Did you miss work, leave early, or cancel plans because of a headache?
  4. What else happens - throwing up, light or noise hurting, seeing spots?
  5. Did your medicine help, and how long did it take?

Rule changes you may hear about

Today's rules (above) are what VA uses unless a change is final.

  • Proposed, not law yet

    VA's 2024 proposed neurological rule keeps the migraine levels the same (it just moves the text).

    Where it stands: Proposed Nov 12, 2024. Not final as of Oct 30, 2026.

    89 FR 88917 (Nov 12, 2024), RIN 2900-AQ73

  • Cancelled, not in force

    On Feb 17, 2026, VA put out a quick rule that would have rated you with the help your medicine gives you (38 CFR 4.10). VA cancelled it 10 days later. The old wording is back. Court case Jones v. Shinseki, 26 Vet. App. 56 (2012) still says: if the rating rule doesn't mention medicine, VA can't lower your rating because medicine helps.

    Where it stands: Rescinded effective Feb 27, 2026. Not in force.

    91 FR 7118 (Feb 17, 2026), interim final rule; 91 FR 9712 (Feb 27, 2026), rescission. RIN 2900-AS49

Sources

Checked against VA's rules on October 30, 2026.

Helping The Brave doesn't file or prepare claims. This guide is free education, not medical or legal advice. The VA examiner measures and VA decides your rating.