{"id":"F2018L00015","name":"Statement of Principles concerning migraine (Balance of Probabilities) (No. 8 of 2018)","slug":"statement-of-principles-concerning-migraine-balance-of-probabilities-no-8-of-2018","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":96642,"registerId":"commonwealth-F2018L00015-current","compilationNumber":null,"startDate":"2026-04-02","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning migraine (Balance of Probabilities) (No. 8 of 2018)","content":"![Commonwealth Coat of Arms](image.001.png)\n\nStatement of Principles concerning migraine (Balance of Probabilities) (No. 8 of 2018)\n\nmade under subsection 196B(3) of the\n\nVeterans' Entitlements Act 1986\n\nCompilation No. 1\n\nCompilation date: 23 March 2020\n\nIncludes amendments up to: Amendment Statement of Principles concerning migraine (Balance of Probabilities) (No. 16 of 2020) (F2020L00204)\n\nThe day of commencement of this Amendment Statement of Principles concerning migraine is 23 March 2020.\n\nAbout this compilation\n\nThis compilation\n\nThis is a compilation of the Statement of Principles concerning migraine (Balance of Probabilities) (No. 8 of 2018) that shows the text of the law as amended and in force on 23 March 2020\n\nThe notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.\n\nUncommenced amendments\n\nThe effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Legislation Register (www.legislation.gov.au). The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the series page on the Legislation Register for the compiled law.\n\nApplication, saving and transitional provisions for provisions and amendments\n\nIf the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.\n\nModifications\n\nIf the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the series page on the Legislation Register for the compiled law.\n\nSelf‑repealing provisions\n\nIf a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.\n\n![RMA-Red](image.002.jpeg)\n\nStatement of Principles\n\nconcerning\n\nMIGRAINE  \n(Balance of Probabilities)\n\n(No. 8 of 2018)\n\nThe Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\nDated 22 December 2017\n\n|     |\n| --- |\n|     |\n\n  \n\nContents\n\n1 Name\n\n2 Commencement\n\n3 Authority\n\n4 Revocation\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\n1 Name\n\nThis is the Statement of Principles concerning migraine (Balance of Probabilities) (No. 8 of 2018).\n\n2 Commencement\n\nThis instrument commences on 29 January 2018.\n\n3 Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n4 Revocation\n\nThe Statement of Principles concerning migraine No. 57 of 2009, made under subsection 196B(3) of the VEA is revoked.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 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 migraine and death from migraine.\n\nMeaning of migraine\n\n(2) For the purposes of this Statement of Principles, migraine:\n\n(a) means migraine without aura, migraine with aura (which includes basilar migraine, sporadic hemiplegic migraine and retinal migraine), chronic migraine and vestibular migraine; and\n\n(b) excludes familial hemiplegic migraine, abdominal migraine, migrainous infarction, amaurosis fugax, cluster headache, tension-type headache, headache attributable to structural abnormalities or inflammatory disorders of the head and neck, and headache attributable to systemic disease.\n\n> Note: chronic migraine, migraine with aura, migraine without aura and vestibular migraine are defined in the Schedule 1 – Dictionary\n\n(3) While migraine attracts ICD‑10‑AM code G43, in applying this Statement of Principles the meaning of migraine 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 migraine\n\n(5) For the purposes of this Statement of Principles, migraine, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's migraine.\n\n> Note: terminal event is defined in the Schedule 1 – Dictionary.\n\n8 Basis for determining the factors\n\nOn the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that migraine and death from migraine can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the MRCA.\n\n> Note: 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 exist before it can be said that, on the balance of probabilities, migraine or death from migraine is connected with the circumstances of a person's relevant service:\n\n(1) undergoing treatment with a nitric oxide donor, at the time of the clinical onset of migraine;\n\n> Note: nitric oxide donor is defined in the Schedule 1 - Dictionary.\n\n(2) undergoing treatment with a nitric oxide donor, at the time of the clinical worsening of migraine;\n\n> Note: clinical worsening of migraine and nitric oxide donor are defined in the Schedule 1 \\- Dictionary.\n\n(3) being obese for at least the five years before the clinical worsening of migraine;\n\n> Note: being obese and clinical worsening of migraine are defined in the Schedule 1 \\- Dictionary.\n\n(4) inability to obtain appropriate clinical management for migraine.\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(2) to 9(4) apply only to material contribution to, or aggravation of, migraine where the person's migraine 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(3) 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\nSchedule 1 \\- Dictionary\n\nNote: See Section 6\n\n1 Definitions\n\nIn this instrument:\n\nbeing obese means having a Body Mass Index (BMI) of 30 or greater.\n\n> Note: BMI is also defined in the Schedule 1 - Dictionary.\n\nBMI means W/H2 where:\n\nW is the person's weight in kilograms; and\n\nH is the person's height in metres.\n\nchronic migraine means a neurological disorder meeting the following diagnostic criteria (derived from ICHD-3):\n\n1.  Headache on greater than 14 days per month for greater than three months, and fulfilling criteria B and C.\n2.  Occurring in a patient who has had at least five attacks of any combination of migraine without aura or migraine with aura.\n3.  On greater than seven days per month for more than three months, fulfilling any of the following:\n    1.  criteria C and D for migraine without aura;\n    2.  criteria B and C for migraine with aura; or\n    3.  believed by the patient to be migraine at onset and relieved by a triptan or ergot derivative.\n4.  Not better accounted for by another ICHD-3 diagnosis.\n\nNote: ICHD-3 is also defined in the Schedule 1 – Dictionary.\n\nclinical worsening of migraine means a change in the nature of the migraine resulting in one or more of the following:\n\n(a) attacks of migraine that are increased in frequency by a factor of two-fold or more;\n\n(b) attacks of migraine that are increased in severity with debilitating, long-lasting symptoms including nausea, vomiting, photophobia or phonophobia;\n\n(c) a conversion from episodic to chronic migraine;\n\n(d) an increase in the requirement for hospitalisation for management of the manifestations or complications of migraine; or\n\n(e) an episode of severe migraine resulting in status migrainosus, cerebral infarct, seizure or death.\n\n> Note: chronic migraine is also defined in the Schedule 1 - Dictionary.\n\nICHD-3 means the International Headache Society: International Classification of Headache Disorders, Third Edition.\n\nmigraine—see subsection 7(2).\n\nmigraine with aura means a neurological disorder meeting the following diagnostic criteria (derived from ICHD-3):\n\n1.  At least two attacks fulfilling criteria B and C.\n2.  One or more of the following fully reversible aura symptoms:\n\n1.  visual;\n2.  sensory;\n3.  speech and/or language;\n4.  motor;\n5.  brainstem; or\n6.  retinal.\n\nC. At least three of the following six characteristics:\n\n1.  at least one aura symptom spreads gradually over ≥5 minutes;\n2.  two or more aura symptoms occur in succession;\n3.  each individual aura symptom lasts between five and 60 minutes. When three symptoms occur during an aura, the acceptable maximal duration is 3 x 60 minutes. Motor symptoms last up to 72 hours;\n4.  at least one aura symptom is unilateral;\n5.  at least one aura symptom is positive; or\n6.  the aura is accompanied, or followed within 60 minutes, by headache.\n\nD. Not better accounted for by another ICHD-3 diagnosis.\n\nNote 1: Migraine with aura is also known as classic or classical migraine and includes migraine with typical aura, migraine with brainstem aura (basilar migraine), sporadic hemiplegic migraine and retinal migraine.\n\nNote 2: ICHD-3 is also defined in the Schedule 1 – Dictionary.\n\nmigraine without aura means a neurological disorder meeting the following diagnostic criteria (derived from ICHD-3):\n\n1.  At least five attacks fulfilling criteria B-D.\n2.  Headache attacks in adults lasting between four and 72 hours (untreated or unsuccessfully treated) and in persons aged under 18 years, attacks lasting between two and 72 hours.\n3.  Headache has at least two of the following four characteristics:\n    1.  unilateral location;\n    2.  pulsating quality;\n    3.  moderate or severe pain intensity; or\n    4.  aggravation by routine physical activity or causing avoidance of routine physical activity.\n4.  During headache at least one of the following:\n    1.  nausea and/or vomiting; or\n    2.  photophobia and phonophobia.\n5.  Not better accounted for by another ICHD-3 diagnosis.\n\nNote 1: Migraine without aura is also known as common migraine.\n\nNote 2: ICHD-3 is also defined in the Schedule 1 – Dictionary.\n\nMRCA means the Military Rehabilitation and Compensation Act 2004.\n\nnitric oxide donor means a pharmacologically active substance that releases nitric oxide in vivo or in vitro and includes amyl nitrate, glyceryl nitrate, isosorbide mononitrate, isosorbide dinitrate, sodium nitroprusside, mannitol hexanitrate and nitrous oxide.\n\nrelevant service means:\n\n(a) eligible war service (other than operational service) under the VEA;\n\n(b) defence service (other than hazardous service and British nuclear test defence service) under the VEA; or\n\n(c) peacetime service under the MRCA.\n\n> Note: MRCA and VEA are also defined in the Schedule 1 - Dictionary.\n\nterminal 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\nVEA means the Veterans' Entitlements Act 1986.\n\nvestibular migraine means a neurological disorder meeting the following diagnostic criteria (derived from ICHD-3):\n\n1.  At least five episodes fulfilling criteria C and D.\n2.  A current or past history of migraine without aura or migraine with aura.\n3.  Vestibular symptoms of moderate or severe intensity, lasting between five minutes and 72 hours with the vestibular symptoms including spontaneous vertigo, positional vertigo, visually-induced vertigo, head motion-induced vertigo, and head motion-induced dizziness with nausea.\n4.  At least half of episodes are associated with at least one of the following three migrainous features:\n    1.  headache with at least two of the following four characteristics:\n\n    a) unilateral location;\n    b) pulsating quality;\n    c) moderate or severe intensity; or\n    d) aggravation by routine physical activity.\n\n2. photophobia and phonophobia; or\n\n3. visual aura.\n\nE. Not better accounted for by another ICHD-3 diagnosis or by another vestibular disorder.\n\nNote: ICHD-3 is also defined in the Schedule 1 – Dictionary.\n\n> Note: Endnotes\n\n> Note: Endnote 1—About the endnotes\n\nThe endnotes provide information about this compilation and the compiled law.\n\nThe following endnotes are included in every compilation:\n\nEndnote 1—About the endnotes\n\nEndnote 2—Abbreviation key\n\nEndnote 3—Legislation history\n\nEndnote 4—Amendment history\n\nAbbreviation key—Endnote 2\n\nThe abbreviation key sets out abbreviations that may be used in the endnotes.\n\nLegislation history and amendment history—Endnotes 3 and 4\n\nAmending laws are annotated in the legislation history and amendment history.\n\nThe legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.\n\nThe amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.\n\nMisdescribed amendments\n\nA misdescribed amendment is an amendment that does not accurately describe the amendment to be made. If, despite the misdescription, the amendment can be given effect as intended, the amendment is incorporated into the compiled law and the abbreviation “(md)” added to the details of the amendment included in the amendment history.\n\nIf a misdescribed amendment cannot be given effect as intended, the abbreviation “(md not incorp)” is added to the details of the amendment included in the amendment history.\n\n> Note: Endnote 2—Abbreviation key\n\n|                                                | o = order(s)                        |\n| ---------------------------------------------- | ----------------------------------- |\n| ad = added or inserted                         | Ord = Ordinance                     |\n| am = amended                                   | orig = original                     |\n| amdt = amendment                               | par = paragraph(s)/subparagraph(s)  |\n| c = clause(s)                                  | /sub‑subparagraph(s)                |\n| C[x] = Compilation No. x                       | pres = present                      |\n| Ch = Chapter(s)                                | prev = previous                     |\n| def = definition(s)                            | (prev…) = previously                |\n| Dict = Dictionary                              | Pt = Part(s)                        |\n| disallowed = disallowed by Parliament          | r = regulation(s)/rule(s)           |\n| Div = Division(s)                              |                                     |\n| exp = expires/expired or ceases/ceased to have | reloc = relocated                   |\n| effect                                         | renum = renumbered                  |\n| F = Federal Register of Legislation            | rep = repealed                      |\n| gaz = gazette                                  | rs = repealed and substituted       |\n| LA = Legislation Act 2003                      | s = section(s)/subsection(s)        |\n| LIA = Legislative Instruments Act 2003         | Sch = Schedule(s)                   |\n| (md) = misdescribed amendment can be given     | Sdiv = Subdivision(s)               |\n| effect                                         | SLI = Select Legislative Instrument |\n| (md not incorp) = misdescribed amendment       | SR = Statutory Rules                |\n| cannot be given effect                         | Sub‑Ch = Sub‑Chapter(s)             |\n| mod = modified/modification                    | SubPt = Subpart(s)                  |\n| No. = Number(s)                                | underlining = whole or part not     |\n|                                                | commenced or to be commenced        |\n\n> Note: Endnote 3—Legislation history\n\n| Name                                                                                              | Registration              | Commencement    | Application, saving and transitional provisions |\n| ------------------------------------------------------------------------------------------------- | ------------------------- | --------------- | ----------------------------------------------- |\n| Statement of Principles concerning migraine (Balance of Probabilities) (No. 8 of 2018)            | 3 January 2018F2018L00015 | 29 January 2018 |                                                 |\n| Amendment Statement of Principles concerning migraine (Balance of Probabilities) (No. 16 of 2020) | 2 March 2020F2020L00204   | 23 March 2020   |                                                 |\n\n> Note: Endnote 4—Amendment history\n\n| Provision affected                                        | How affected       |\n| --------------------------------------------------------- | ------------------ |\n| Subsection 7(2)………..                                      | rs. No. 16 of 2020 |\n| Schedule 1 – Dictionary – chronic migraine…….             | rs. No. 16 of 2020 |\n| Schedule 1 – Dictionary – ICHD-3……………….                   | ad. No. 16 of 2020 |\n| Schedule 1 – Dictionary – migraine with aura….            | ad. No. 16 of 2020 |\n| Schedule 1 – Dictionary – migraine without aura……………….……. | ad. No. 16 of 2020 |\n| Schedule 1 – Dictionary – vestibular migraine….           | ad. No. 16 of 2020 |","sortOrder":0}],"analysis":{"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"The instrument revokes the earlier Statement of Principles (No. 57 of 2009) (section 4) and, per the amendment history, updates and clarifies definitions and diagnostic criteria in Schedule 1 (see subsection 7(2) and endnote 4). Amendments add ICHD‑3 references and refine migraine subtype definitions, altering the technical scope of what is recognised as 'migraine' for claims assessment."},"complexity_factors":["Technical diagnostic criteria for multiple migraine subtypes (ICHD‑3‑derived) require specialist medical interpretation — Schedule 1 (chronic, with/without aura, vestibular).","Causation standard is 'balance of probabilities' but requires proof that listed factors are related to relevant service — section 8 and section 10(1).","Temporal and legal limits on contribution/aggravation: some factors apply only where migraine pre‑existed service — section 10(2).","Use of a mix of objective thresholds (BMI ≥30) and clinical judgments (clinical worsening; inability to obtain appropriate clinical management) creates variable evidentiary burdens — Schedule 1 (being obese, BMI); section 9(4).","Precise exposure categories (named nitric oxide donors) narrow the pharmacological class but require toxicological/medication records — Schedule 1 (nitric oxide donor); sections 9(1)–9(2).","Cross‑reference to external classifications increases complexity of medical evidence (ICD‑10‑AM; ICHD‑3) — section 7(3)–(4); Schedule 1.","Interplay with other Statements of Principles when factors refer to other injuries/diseases requires concurrent application of other instruments — section 11.","Definitions and amendments affecting scope are detailed in the Schedule and endnotes, requiring attention to amendment history when assessing claims — section 6; endnotes."],"plain_english_summary":"This Statement of Principles sets the medical criteria used to decide, on the balance of probabilities, whether migraine (and death from migraine) is connected to a veteran’s relevant service under the VEA or the MRCA. It lists the migraine types covered and the clinical or exposure factors (for example, treatment with nitric oxide donors, obesity for at least five years prior to worsening, or inability to obtain appropriate clinical management) that, if shown to be related to service, can establish a service connection and affect entitlement claims."},"kimi_summary":{"content_quality":"ok","complexity_score":5,"scope_assessment":{"changed":false,"description":"This legislation maintains its original narrow scope as a specific medical determination for migraine under the veterans' compensation scheme. The 2020 amendments updated medical definitions to align with current ICHD-3 standards but did not expand the legislative purpose beyond establishing criteria for service connection of migraine claims."},"complexity_factors":["Multiple nested definitions: 15 defined terms in Schedule 1, with several terms (like 'chronic migraine') containing multi-part diagnostic criteria referencing external medical standards (ICHD-3)","Cross-referencing between instruments: Section 11 creates a web of dependencies by incorporating factors from other Statements of Principles by reference","Conditional logic in Section 9: Four alternative factors with 'at least one must exist' structure, but Section 10(2) imposes temporal restrictions on factors 2-4 (only apply to pre-existing conditions)","Medical terminology density: Extensive use of ICD-10-AM codes and ICHD-3 diagnostic criteria requiring external medical knowledge","Dual legislative framework application: Operates under both Veterans' Entitlements Act 1986 and Military Rehabilitation and Compensation Act 2004 with different service definitions","Technical medical definitions: 'Clinical worsening' includes five distinct sub-criteria (frequency, severity, conversion to chronic, hospitalisation, complications)","Mathematical formula for obesity: BMI calculation defined as W/H² with specific units required"],"plain_english_summary":"This rulebook sets the medical criteria the Repatriation Medical Authority and Department of Veterans' Affairs use to decide whether migraines are service-related for veterans and defence personnel. It identifies specific clinical factors—including use of nitric oxide medications at onset or worsening, prolonged obesity, and inability to access treatment—that, if proven on the balance of probabilities, support a service connection.\n\nIt replaces the 2009 guidance and notes obesity/worsening factors only apply where migraine existed before or during service."},"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"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-migraine-balance-of-probabilities-no-8-of-2018","history":"/api/acts/statement-of-principles-concerning-migraine-balance-of-probabilities-no-8-of-2018/history","analysis":"/api/acts/statement-of-principles-concerning-migraine-balance-of-probabilities-no-8-of-2018/analysis","conflicts":"/api/acts/statement-of-principles-concerning-migraine-balance-of-probabilities-no-8-of-2018/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-migraine-balance-of-probabilities-no-8-of-2018/important-cases","documents":"/api/acts/statement-of-principles-concerning-migraine-balance-of-probabilities-no-8-of-2018/documents"}}