Headache is the most commonly reported symptom following traumatic brain injury, including the mild TBIs and concussions many veterans sustained from blasts, vehicle accidents, falls, and training injuries. When those headaches persist and meet migraine criteria, they raise both a service-connection question and a rating question with some particular VA rules attached.
This guide explains both. For the general framework, see how migraine service connection works.
Post-traumatic headache
Post-traumatic headache is a recognized clinical entity: headache that develops in close temporal relationship to a head injury. Many post-traumatic headaches have migraine features - throbbing pain, nausea, light and sound sensitivity - and are described clinically as migraine-type.
The important point for a claim is that a documented head injury during service provides a concrete in-service event, which is one of the three elements of direct service connection. The remaining questions are the current diagnosis and the medical nexus between the two.
Direct versus secondary connection after TBI
Headaches after a head injury can be claimed two ways. If the head injury occurred in service and the headaches trace back to it, the claim is a direct one. If the veteran already has service-connected residuals of TBI and the headaches arise from those residuals, secondary service connection under 38 CFR 3.310 applies.
The practical difference is often small, but the evidence is framed differently. A direct claim emphasizes the in-service injury and continuity of symptoms; a secondary claim emphasizes the established TBI residuals and the medical link from those residuals to the headaches.
How the VA rates TBI residuals and headaches
Residuals of traumatic brain injury are evaluated under 38 CFR 4.124a, Diagnostic Code 8045. That code directs the VA to evaluate three main areas of dysfunction - cognitive, emotional/behavioral, and physical - and it specifically provides that distinct, diagnosable residuals are evaluated under the appropriate diagnostic code for that condition.
For headaches, that generally means a separately diagnosed migraine or headache disorder is evaluated under the headache criteria rather than being folded into a general TBI evaluation. The rule against pyramiding still applies: the same symptom cannot be compensated twice, so the record should document the headache disorder as a distinct residual with its own findings.
Where veterans start
Every case is different, and there is no obligation at any step. When veterans want to understand what their records actually support, these are the two most common starting points:
- Medical records review
A licensed physician reviews your records for a $250 flat fee and identifies which conditions the available evidence may support. The fee is refunded in full if nothing supportable is identified.
- Nexus letter
When the records support one, a licensed provider writes the medical opinion that addresses the link between your migraines and your service or an already service-connected condition.
Documenting a TBI-related headache claim
Evidence that addresses both the injury and the resulting headache pattern:
- Records of the in-service head injury - incident reports, line-of-duty documentation, medical evaluations, or a buddy statement when records are incomplete
- Post-deployment health assessments and any TBI screening results
- Current diagnosis of migraine or post-traumatic headache from a treating provider
- A headache diary documenting frequency, duration, and prostrating character of attacks
- Treatment records showing the course of headaches from the injury forward
- A reasoned medical opinion connecting the documented injury to the current headache disorder
When the in-service injury is poorly documented
Many head injuries were never formally documented - a concussion treated on the spot, a blast exposure with no medical visit. Lay evidence becomes important here. The veteran's own credible account of the incident and its immediate aftermath, along with statements from people who were present or who noticed changes afterward, can establish the in-service event even when the treatment records are silent.
A medical opinion can then evaluate whether the current headache disorder is at least as likely as not related to that event, given the described mechanism and the pattern of symptoms since.
Rating the headaches themselves
Once connected, headaches after TBI are rated by frequency and severity of prostrating attacks - 0, 10, 30, or 50 percent - as explained in the migraine ratings guide. Because TBI residuals often include several separately rated conditions, it is worth seeing how the ratings combine using our VA disability calculator.
Where to start
TBI-related claims often hinge on documentation gaps from years ago. A medical records review evaluates what your file actually establishes about the injury and the headache history before any opinion is written. There is no obligation beyond the review.