{"id":"F2018L00902","name":"Statement of Principles concerning cluster headache (Reasonable Hypothesis) (No. 57 of 2018)","slug":"statement-of-principles-concerning-cluster-headache-reasonable-hypothesis-no-57-of-2018","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439680,"registerId":"F2018L00902-fast-fetch-1775955612529","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning cluster headache (Reasonable Hypothesis) (No. 57 of 2018)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\nmeta-generator: Aspose.Words for .NET 20.2\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n\n\n \n\nStatement of Principles\n\nconcerning\n\nCLUSTER HEADACHE (Reasonable Hypothesis)\n\n(No. 57 of 2018)\n\nThe Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\n \n\nDated 22 June 2018\n\n \n\n \n\n \n\n \n\n \n\n \n\n| The Common Seal of the Repatriation Medical Authority was affixed to this instrument at the direction of:
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Professor Nicholas Saunders AO
Chairperson
|\n\n\n \n\n \n\n\nContents\n\n1 Name\n\n2 Commencement\n\n3 Authority\n\n4 Repeal\n\n5 Application\n\n6 Definitions\n\n7 Kind of injury, disease or death to which this Statement of Principles relates\n\n8 Basis for determining the factors\n\n9 Factors that must exist\n\n10 Relationship to service\n\n11 Factors referring to an injury or disease covered by another Statement of Principles\n\nSchedule 1 - Dictionary\n\n1 Definitions\n\n \n\n\n\n\n1 Name\n\nThis is the Statement of Principles concerning cluster headache (Reasonable Hypothesis) (No. 57 of 2018).\n\n2 Commencement\n\n This instrument commences on 23 July 2018.\n\n3 Authority\n\nThis instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning cluster headache No. 20 of 2010 (Federal Register of Legislation No. F2010L01036) made under subsection 196B(2) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004 applies.\n\n6 Definitions\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n7 Kind of injury, disease or death to which this Statement of Principles relates\n\n(1) This Statement of Principles is about cluster headache and death from cluster headache.\n\nMeaning of cluster headache\n\n(2) For the purposes of this Statement of Principles, cluster headache:\n\n(a) means a headache condition in which there are multiple attacks of severe, unilateral headache in the orbital, supraorbital or temporal region, where each headache typically lasts from 15 to 180 minutes. The headache is accompanied by a sense of restlessness or agitation, or at least one of the following autonomic symptoms occurring on the same side as the pain:\n\n(i) conjunctival injection or lacrimation;\n\n(ii) eyelid oedema;\n\n(iii) forehead and facial sweating;\n\n(iv) miosis or ptosis; or\n\n(v) nasal congestion or rhinorrhoea; and\n\n(b) includes episodic cluster headache and chronic cluster headache; and\n\n(c) excludes:\n\n(i) headache attributable to inflammatory disorders of the head and neck;\n\n(ii) headache attributable to structural abnormalities;\n\n(iii) headache attributable to systemic disease;\n\n(iv) hemicrania continua;\n\n(v) migraine;\n\n(vi) paroxysmal hemicrania;\n\n(vii) short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT);\n\n(viii) short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA);\n\n(ix) tension-type headache; and\n\n(x) trigeminal neuralgia.\n\nNote: Headache attacks in cluster headache typically occur at a frequency between one every other day and eight per day. In episodic cluster headache disorder only, cluster headache attacks occur in bouts separated by asymptomatic periods which are free from cluster headache attacks.\n\n(3) While cluster headache attracts ICD‑10‑AM code G44.0, in applying this Statement of Principles the meaning of cluster headache is that given in subsection (2).\n\n(4) For subsection (3), a reference to an ICD-10-AM code is a reference to the code assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM), Tenth Edition, effective date of 1 July 2017, copyrighted by the Independent Hospital Pricing Authority, ISBN 978-1-76007-296-4.\n\nDeath from cluster headache\n\n(5) For the purposes of this Statement of Principles, cluster headache, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's cluster headache.\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n8 Basis for determining the factors\n\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that cluster headache and death from cluster headache can be related to relevant service rendered by veterans, members of Peacekeeping Forces, or members of the Forces under the VEA, or members under the MRCA.\n\nNote: MRCA, relevant service and VEA are defined in the Schedule 1 – Dictionary.\n\n9 Factors that must exist\n\nAt least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting cluster headache or death from cluster headache with the circumstances of a person's relevant service:\n\n(1) having trauma to the skull or face of the affected side within the seven days before the clinical onset of cluster headache;\n\nNote: trauma to the skull or face is defined in the Schedule 1 - Dictionary. \n\n(2) having concussion or moderate to severe traumatic brain injury before the clinical onset of cluster headache, where cluster headache has developed within the seven days of:\n\n(a) injury to the head; or\n\n(b) regaining consciousness following the injury to the head; or\n\n(c) discontinuing medication that impairs the ability to sense or report headache following the injury to the head;\n\n(3) undergoing eye exenteration of the affected side within the two years before the clinical onset of cluster headache;\n\nNote: exenteration is defined in the Schedule 1 - Dictionary. \n\n(4) having sleep apnoea at the time of the clinical onset of cluster headache;\n\n(5) smoking at least ten pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of cluster headache;\n\nNote: pack-years of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary. \n\n(6) using intranasal cocaine at least four times per month for the one year before the clinical onset of cluster headache;\n\n(7) having sleep apnoea at the time of the clinical worsening of cluster headache;\n\n(8) smoking at least ten pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical worsening of cluster headache;\n\nNote: pack-years of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary. \n\n(9) taking glyceryl trinitrate, isosorbide mononitrate or isosorbide dinitrate within the 24 hours before the clinical worsening of cluster headache;\n\n(10) consuming alcohol within the 24 hours before the clinical worsening of cluster headache;\n\n(11) being treated with sildenafil within the 24 hours before the clinical worsening of cluster headache;\n\n(12) inability to obtain appropriate clinical management for cluster headache.\n\n10 Relationship to service\n\n(1) The existence in a person of any factor referred to in section 9, must be related to the relevant service rendered by the person.\n\n(2) The factors set out in subsections 9(7) to 9(12) apply only to material contribution to, or aggravation of, cluster headache where the person's cluster headache was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n\n11 Factors referring to an injury or disease covered by another Statement of Principles\n\nIn this Statement of Principles:\n\n(1) if a factor referred to in section 9 applies in relation to a person; and\n\n(2) that factor refers to an injury or disease in respect of which a Statement of Principles has been determined under subsection 196B(2) of the VEA;\n\nthen the factors in that Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.\n\n \n\n \n\nSchedule 1 - Dictionary \n\nNote: See Section 6\n\n1 Definitions\n\nIn this instrument:\n\n cluster headache—see subsection 7(2).\n\n exenteration means removal of the entire contents of the orbit of the eye including the eye and extraocular muscles.\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n pack-years of cigarettes, or the equivalent thereof in other tobacco products means a calculation of consumption where one pack-year of cigarettes equals 20 tailor-made cigarettes per day for a period of one calendar year, or 7 300 cigarettes. One tailor-made cigarette approximates one gram of tobacco or one gram of cigar or pipe tobacco by weight. One pack-year of tailor-made cigarettes equates to 7.3 kilograms of smoking tobacco by weight. Tobacco products mean cigarettes, pipe tobacco or cigars, smoked alone or in any combination.\n\n relevant service means:\n\n(a) operational service under the VEA;\n\n(b) peacekeeping service under the VEA;\n\n(c) hazardous service under the VEA;\n\n(d) British nuclear test defence service under the VEA;\n\n(e) warlike service under the MRCA; or\n\n(f) non-warlike service under the MRCA.\n\nNote: MRCA and VEA are also defined in the Schedule 1 - Dictionary.\n\n terminal event means the proximate or ultimate cause of death and includes the following:\n\n(a) pneumonia;\n\n(b) respiratory failure;\n\n(c) cardiac arrest;\n\n(d) circulatory failure; or\n\n(e) cessation of brain function.\n\n trauma to the skull or face means an injury to any or all of those areas of the head, resulting in:\n\n(a) fracture of the underlying bones; or\n\n(b) laceration of the overlying skin; or\n\n(c) external bruise at the site of the trauma.\n\n VEA means the Veterans' Entitlements Act 1986.\n\n \n\n \n","sortOrder":0}],"analysis":{"flash_summary_failed":{"failed":true,"reason":"A positive credit balance is required for all requests, including BYOK, so fallback providers remain available. Add credits at https://vercel.com/d?to=%2F%5Bteam%5D%2F%7E%2Fai%3Fmodal%3Dtop-up to continue.","source":"analysis-cron"},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This instrument maintains the standard scope of Repatriation Medical Authority Statements of Principles. It replaces the 2010 version with updated medical evidence but does not expand beyond the traditional purpose of establishing causal factors for veterans' compensation claims. The structure follows the standard template: definition, factors for onset, factors for worsening, relationship to service requirements, and dictionary."},"complexity_factors":["Moderate medical terminology requiring definitions (e.g., 'exenteration', 'pack-years', 'SUNCT', 'SUNA')","12 distinct factors with varying temporal windows (7 days, 2 years, 24 hours, 'at the time of')","Conditional logic in section 10(2) restricting factors 7-12 to aggravation cases only","Cross-referencing mechanism in section 11 linking to other Statements of Principles","Specific exclusion list of 10 other headache conditions in section 7(2)(c)","Dual statutory framework application (VEA and MRCA with different service definitions)","Precise clinical definitions required (ICD-10-AM coding with specific edition reference)"],"plain_english_summary":"This Statement of Principles sets the medical and factual factors (12 in total) used to decide if cluster headache can be connected to military service under the \"reasonable hypothesis\" test. It affects veterans, peacekeepers and current/former defence members claiming under the VEA or MRCA, identifying service-linked causes or aggravators—eg. recent head trauma, concussion, sleep apnoea, heavy smoking, intranasal cocaine, certain drugs/alcohol or lack of treatment. It updates the 2010 guidance to ensure consistent decisions."},"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the 2010 Statement and replaces it with the 2018 Statement (section 4). Practically, the 2018 Statement alters the operational scope by specifying a set of qualifying factors (and time windows) that raise a reasonable hypothesis. Compared with a generic approach, the 2018 Statement narrows and formalises the routes by which cluster headache may be linked to service (for example, adding or specifying sleep apnoea, a quantified smoking threshold (10 pack‑years), intranasal cocaine frequency, eye exenteration timing, and particular short‑term exposures that worsen symptoms). These changes affect which claimants will automatically benefit from the \"reasonable hypothesis\" standard and which will need to rely on other evidence or instruments; therefore the scope of practical coverage has been changed from the earlier Statement."},"complexity_factors":["Multiple defined terms in Schedule 1 (cluster headache, exenteration, pack‑years, relevant service, terminal event, trauma, MRCA, VEA) — ~8 core definitions","A relatively short instrument but with 12 discrete qualifying factors in section 9, several of which contain nested timing or conditional clauses","Tight temporal conditions (e.g. onset within 7 days, exenteration within 2 years, exposures within 24 hours) that require precise factual proof","Cross‑references to other legal instruments and classifications: VEA and MRCA claim sections (application), other RMA Statements of Principles (section 11), and ICD‑10‑AM code reference (section 7(3)–(4))","Exclusions list inside the cluster headache definition enumerating 10 other headache disorders (section 7(2)(c)), increasing diagnostic precision requirements","Distinction between causation and aggravation rules (section 10(2)) creating branching application logic","Repeal and replacement of earlier Statement (section 4) — requires practitioners to compare instruments where prior claims exist"],"plain_english_summary":"**What this instrument does (mechanics)\n\n- Replaces an earlier Repatriation Medical Authority (RMA) Statement of Principles about cluster headache and sets the medical criteria that raise a \"reasonable hypothesis\" that a person’s cluster headache (or death from it) is related to their relevant service (see sections 1–5, 7–9). It commenced on 23 July 2018 (section 2) and repeals the 2010 Statement (section 4). \n\n- Defines \"cluster headache\" for the purposes of veterans' entitlement claims, lists clinical features required for that diagnosis, and expressly excludes other headache disorders (section 7(2)–(4)). It also treats death from a terminal event to which cluster headache contributed as included (section 7(5) and Schedule 1).\n\n- Lists specific factors which, if present, are sufficient to raise the required \"reasonable hypothesis\" linking cluster headache (or death from it) to service. Those factors include recent head or facial trauma, concussion or moderate–severe traumatic brain injury with very tight timing requirements, eye exenteration, diagnosed sleep apnoea, a defined smoking history (10 pack‑years), regular intranasal cocaine use, and a set of exposures or clinical-management failures that can materially worsen or aggravate the condition (section 9 and Schedule 1).\n\n- Requires that any of the listed factors be related to the person's \"relevant service\" (section 10). Some factors (those in subsections 9(7)–9(12)) apply only when the cluster headache pre‑existed or was suffered during service and the factor materially contributed to or aggravated the condition (section 10(2)).\n\n- Where a listed factor refers to an injury or disease that itself is covered by another RMA Statement of Principles, the rules in that other Statement apply (section 11).\n\n\nWhat the RMA claims it is doing (purpose claim) and how that matters in practice\n\n- The RMA states it relies on sound medical‑scientific evidence that cluster headache (and death from it) can be related to relevant military service (section 8). The instrument operationalises that view by setting out the medical and exposure criteria which, if met, raise a \"reasonable hypothesis\" linking the condition to service—lower than a legal onus of proof but sufficient to require the decision‑maker to consider service connection under the VEA/MRCA claims processes (sections 5, 9–10).\n\n\nWho pays, who decides, and what behaviour changes\n\n- Who pays: If a claim succeeds under the VEA or MRCA processes that apply this Statement, the Department (or the Scheme that administers entitlements under those Acts) provides the relevant benefit or compensation. This instrument does not itself pay benefits; it defines the medical criteria used by decision‑makers.\n\n- Who decides: The RMA sets the medical criteria; the Department (or the MRCA decision apparatus) applies them to individual claims. Medical assessors and claims officers will use the criteria in sections 7–11 to decide whether a reasonable hypothesis is raised.\n\n- What behaviour changes: Claimants and their clinicians will focus on documenting the specific factors listed (timing of head trauma, diagnosis of sleep apnoea, smoking history in pack‑years, intranasal cocaine use, recent use of nitrates/alcohol/sildenafil, records of eye exenteration, and evidence of access to appropriate clinical management). Accurate clinical records and timing information (e.g. ‘‘within 7 days’’ or ‘‘within 24 hours’’) become material to establishing a claim.\n\n\nCosts, incentives, trade-offs and implementation risks (practical effects)\n\n- Financial and distributional effects: The Statement concentrates benefits on claimants who can establish one or more listed factors tied to relevant service. The public cost is the Department’s obligation on accepted claims; the instrument itself does not quantify cost.\n\n- Evidence burden and administrative cost: Several factors require tight temporal evidence (e.g. onset within 7 days of head injury; worsening within 24 hours of exposure). That raises evidentiary and administrative burdens for claimants, clinicians and decision‑makers (sections 9(1)–9(3), 9(9)–9(11)).\n\n- Reliance on non‑clinical exposures: Some factors (smoking history, intranasal cocaine use, alcohol or recent medication use) may be self‑reported and harder to verify objectively, which can complicate decision‑making and create scope for contested factual questions (sections 9(5)–9(6), 9(9)–9(11)).\n\n- Interaction with other Statements: Where a factor refers to another injury or disease that has its own Statement of Principles, that other Statement’s rules apply (section 11). This creates cross‑reference dependencies and requires decision‑makers to consult multiple instruments for some claims.\n\n- Restriction vs. extension of coverage: The Statement sets specific, narrow pathways (listed factors and timing windows) that raise a reasonable hypothesis. For persons lacking those factors, a reasonable hypothesis is not established by this document alone; they may still pursue claims via other evidence, but the Statement does not assist them directly (section 9).\n\n- Potential for strategic documentary focus: Because the Statement lists discrete qualifying factors, claimants and treating clinicians have incentives to assemble documentation targeted at those factors (e.g. sleep apnoea diagnosis, smoking pack‑year calculations, records of head injury). That is a behavioural effect of the rule structure, not a judgment about intent.\n\n\nConcrete features to note (selected mechanics and definitions)\n\n- \"Cluster headache\" is carefully defined with required features and a non‑exhaustive list of excluded headache disorders (section 7(2)).\n- Time windows are tight for some causes: e.g. trauma/concussion leading to onset within 7 days; eye exenteration within 2 years (section 9(1)–9(3)).\n- Smoking is quantified as at least 10 pack‑years with a defined conversion for cigarettes, cigars and pipe tobacco (Schedule 1).\n- The Statement covers death from cluster headache where death arises from a terminal event to which the cluster headache contributed (section 7(5) and Schedule 1 definition of \"terminal event\").\n\n\nBottom line\n\n- This is a rule‑based medical criteria instrument that tells claims decision‑makers which specific clinical features or exposures will, if related to relevant service, raise a reasonable hypothesis that cluster headache (or death from it) is service‑related (sections 7–11). It updates and replaces the prior RMA Statement (section 4). The practical effects are to focus evidentiary efforts and administrative decision‑making on the narrow list of qualifying factors and their temporal links to service, while leaving other potential causal paths outside the assistance of this Statement."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-cluster-headache-reasonable-hypothesis-no-57-of-2018","history":"/api/acts/statement-of-principles-concerning-cluster-headache-reasonable-hypothesis-no-57-of-2018/history","analysis":"/api/acts/statement-of-principles-concerning-cluster-headache-reasonable-hypothesis-no-57-of-2018/analysis","conflicts":"/api/acts/statement-of-principles-concerning-cluster-headache-reasonable-hypothesis-no-57-of-2018/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-cluster-headache-reasonable-hypothesis-no-57-of-2018/important-cases","documents":"/api/acts/statement-of-principles-concerning-cluster-headache-reasonable-hypothesis-no-57-of-2018/documents"}}