{"id":"F2018L00012","name":"Statement of Principles concerning migraine (Reasonable Hypothesis) (No. 7 of 2018)","slug":"statement-of-principles-concerning-migraine-reasonable-hypothesis-no-7-of-2018","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":96638,"registerId":"commonwealth-F2018L00012-current","compilationNumber":null,"startDate":"2026-04-02","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning migraine (Reasonable Hypothesis) (No. 7 of 2018)","content":"![Commonwealth Coat of Arms](image.001.png)\n\nStatement of Principles concerning migraine (Reasonable Hypothesis) (No. 7 of 2018)\n\nmade under subsection 196B(2) of the\n\nVeterans' Entitlements Act 1986\n\nCompilation No. 2\n\nCompilation date: 23 March 2020\n\nIncludes amendments up to: Amendment Statement of Principles concerning migraine (Reasonable Hypothesis) (No. 15 of 2020) (F2020L00202)\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 (Reasonable Hypothesis) (No. 7 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(Reasonable Hypothesis)\n\n(No. 7 of 2018)\n\nThe Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\nDated 22 December 2017\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 (Reasonable Hypothesis) (No. 7 of 2018).\n\n2 Commencement\n\nThis instrument commences on 29 January 2018.\n\n3 Authority\n\nThis instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\n4 Revocation\n\nThe Statement of Principles concerning migraine No. 56 of 2009, made under subsection 196B(2) of the VEA is revoked.\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 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\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that migraine and death from migraine 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\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 as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting migraine or death from migraine 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) having severe and persistent asthma within the five years before the clinical onset of migraine;\n\n> Note: severe and persistent asthma is defined in the Schedule 1 - Dictionary.\n\n(2a) having concussion or moderate to severe traumatic brain injury before the clinical onset of migraine, where migraine 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 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(4) having severe and persistent asthma within the five years before the clinical worsening of migraine;\n\n> Note: clinical worsening of migraine and severe and persistent asthma are defined in the Schedule 1 - Dictionary.\n\n(4a) having concussion or moderate to severe traumatic brain injury before the clinical worsening of migraine, where migraine has worsened 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(5) 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(6) 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(3) to 9(6) 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(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\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) 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\n> Note: MRCA and VEA are also defined in the Schedule 1 - Dictionary.\n\nsevere and persistent asthma means asthma having any of the following specified characteristics, alone or in combination, for a cumulative period of at least six months within a continuous one year period:\n\n(a) FEV1 (forced expiratory volume in one second) of 60% or less of expected value;\n\n(b) wheeze, tightness, cough, dyspnoea or other symptoms occurring throughout each day;\n\n(c) frequent flare-ups;\n\n(d) the presence of night-time symptoms on more than one night per week; or\n\n(e) symptoms frequently restrict activity or sleep.\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 (Reasonable Hypothesis) (No. 7 of 2018)            | 3 January 2018F2018L00012  | 29 January 2018  |                                                 |\n| Amendment Statement of Principles concerning migraine (Reasonable Hypothesis) (No. 98 of 2018) | 29 October 2018F2018L01499 | 26 November 2018 |                                                 |\n| Amendment Statement of Principles concerning migraine (Reasonable Hypothesis) (No. 15 of 2020) | 2 March 2020F2020L00202    | 23 March 2020    |                                                 |\n\n> Note: Endnote 4—Amendment history\n\n| Provision affected                                        | How affected       |\n| --------------------------------------------------------- | ------------------ |\n| Subsection 9(2a)………                                       | ad. No. 98 of 2018 |\n| Subsection 9(4a)………                                       | ad. No. 98 of 2018 |\n| Subsection 7(2)………..                                      | rs. No. 15 of 2020 |\n| Schedule 1 – Dictionary – chronic migraine…….             | rs. No. 15 of 2020 |\n| Schedule 1 – Dictionary – ICHD-3……………….                   | ad. No. 15 of 2020 |\n| Schedule 1 – Dictionary – migraine with aura….            | ad. No. 15 of 2020 |\n| Schedule 1 – Dictionary – migraine without aura……………….……. | ad. No. 15 of 2020 |\n| Schedule 1 – Dictionary – vestibular migraine….           | ad. No. 15 of 2020 |","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":6,"scope_assessment":{"changed":false,"description":"The legislation maintains its original scope as a specific medical-determination instrument for migraine conditions under the veterans' compensation scheme. The 2020 amendments expanded the technical definitions of migraine subtypes to align with updated international medical standards (ICHD-3), but this represents refinement of the existing medical framework rather than expansion beyond the original purpose of determining service connection for migraine claims."},"complexity_factors":["Multiple nested definitions: 15 defined terms in Schedule 1, with several cross-referencing each other (e.g., 'chronic migraine' references 'ICHD-3', which is separately defined)","Medical diagnostic criteria incorporated by reference: Four separate conditions (chronic migraine, migraine with aura, migraine without aura, vestibular migraine) each include multi-part diagnostic criteria derived from external medical standards (ICHD-3)","Temporal conditions with multiple triggers: Factors in sections 9(2a) and 9(4a) require establishing both a prior injury AND a specific 7-day window with three alternative commencement points (injury, regaining consciousness, or discontinuing medication)","Dual pathways for onset vs. worsening: Section 9 creates parallel but slightly different factor sets for 'clinical onset' (subsections 1-2a) versus 'clinical worsening' (subsections 3-6), with subsection 9(6) applying only to worsening","Exclusionary definitions: Section 7(2)(b) contains a lengthy list of 8 specific excluded conditions that must be distinguished from the covered migraine types","Cross-legislative references: Operates across two separate Acts (Veterans' Entitlements Act 1986 and Military Rehabilitation and Compensation Act 2004) with defined terms bridging both schemes","Conditional application in Section 10(2): Creates a limitation where certain factors only apply to aggravation of pre-existing conditions, not initial onset"],"plain_english_summary":"This Statement of Principles sets the medical rules for when a veteran’s migraine can be linked to military service for compensation. It uses a “reasonable hypothesis” test: if a veteran shows at least one specified service‑related factor around onset or worsening (eg, certain medications, recent concussion/TBI, severe asthma, long‑term obesity, or lack of treatment), the migraine may be service‑connected. It defines which migraine types qualify and matters for veterans, decision‑makers, and medical evidence for claims."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument broadened and updated the scope compared with the revoked 2009 Statement of Principles. Amendments introduced after 2009 (see endnotes) added specific new qualifying factors (notably concussion/moderate–severe traumatic brain injury factors in subsections 9(2a) and 9(4a) inserted by No. 98 of 2018), introduced obesity and inability to obtain appropriate clinical management as factors (s.9(5) and s.9(6)), and updated the migraine subtype definitions and diagnostic references to align with ICHD‑3 (amendments by No. 15 of 2020 reflected in Schedule 1 and s.7(2)). These changes expand the medical grounds on which a reasonable hypothesis may be found and tighten the instrument’s reliance on modern diagnostic standards, thereby changing both the substantive pathways to an entitlement finding and the evidentiary expectations for claimants."},"complexity_factors":["Relatively short instrument (11 sections plus Schedule 1) but with substantive medical detail","Multiple cross‑references to external clinical classifications (ICD‑10‑AM and ICHD‑3)","Approximately 12 defined terms in Schedule 1 directly used in the tests (e.g. chronic migraine, clinical worsening, nitric oxide donor, severe and persistent asthma, being obese, BMI, terminal event, MRCA, VEA, relevant service, vestibular migraine)","Conditional logic and time windows (e.g. five‑year windows for asthma/obesity; seven‑day window for post‑concussion onset or worsening)","Nested subclauses in sections 9(2a)/9(4a) specifying alternative triggering events (injury, regaining consciousness, ceasing medication)","Cross‑application rule to other Statements of Principles (s.11) creates networked dependencies","Diagnostic criteria for migraine subtypes reproduced in the Schedule (detailed, clinical, multi‑part conditions)"],"plain_english_summary":"**What this instrument is and who it affects**\n\n- This is a \"Statement of Principles\" (SOP) produced by the Repatriation Medical Authority (RMA).  It is used when deciding whether a person’s migraine (or death from migraine) can be connected to their military \"relevant service\" for the purpose of claims under the Veterans' Entitlements Act 1986 (VEA) or the Military Rehabilitation and Compensation Act 2004 (MRCA) (see s.3, s.5, s.8).\n\n- The instrument affects veterans and former service members (and their estates) who lodge claims under the VEA or MRCA that assert migraine was caused by, or materially contributed to or aggravated by, their service.\n\n**What the instrument does, mechanically**\n\n- Defines the kind of migraine covered and the diagnostic standards to be used (it adopts definitions derived from ICHD‑3 and refers to ICD‑10‑AM codes) (see s.7(2)–(4) and Schedule 1).\n\n- Lists the specific factors that, where present and linked to the person's relevant service, are sufficient to raise a \"reasonable hypothesis\" that the migraine is related to service (see s.9). At least one of these factors must exist for the reasonable‑hypothesis test:\n  - treatment with a \"nitric oxide donor\" at the time of clinical onset or clinical worsening of migraine (s.9(1) and 9(3));\n  - severe and persistent asthma within five years before clinical onset or clinical worsening (s.9(2) and 9(4));\n  - concussion or moderate–severe traumatic brain injury where migraine began or worsened within seven days of the head injury/regaining consciousness/ceasing medication that masks headache (s.9(2a) and 9(4a));\n  - obesity (BMI ≥ 30) for at least five years before clinical worsening (s.9(5));\n  - inability to obtain appropriate clinical management for migraine (s.9(6)).\n\n- Requires that any of those factors relied upon must be related to the person's relevant service (s.10(1)). Sections 9(3)–9(6) are limited to cases where the migraine was suffered or contracted before or during (but did not arise out of) the relevant service and are applied to material contribution or aggravation only (s.10(2)).\n\n- Cross‑references other Statements of Principles: if a listed factor refers to an injury/disease that is the subject of another SOP, the terms of that other SOP apply (s.11).\n\n- Replaces the prior migraine SOP (revokes the 2009 SOP) and incorporates later amendments (see s.4 and endnotes).\n\n**Why it matters (official purpose and operational effect)**\n\n- Officially, the RMA states there is sound medical‑scientific evidence that migraine and death from migraine can be related to relevant service; this SOP sets the medical/technical thresholds used to decide whether a \"reasonable hypothesis\" exists linking migraine to service (s.8).\n\n- Operationally, the SOP does not itself award benefits. Instead it sets the clinical/legal threshold for causal connection that decision‑makers (Department of Veterans' Affairs decision officers and medical reviewers applying the VEA/MRCA) use when assessing claims. If the SOP's tests are met and the causal connection is accepted under the VEA/MRCA decision framework, entitlements under those Acts may follow.\n\n**Practical implications (evidence, incentives, and implementation mechanics)**\n\n- Evidence burden and documentation: claimants will typically need contemporaneous medical records, medication records (showing nitric oxide donor use), BMI history, asthma test results or records establishing \"severe and persistent\" asthma, and records of head injury timing to meet the SOP factors (See s.9 and Schedule 1 definitions).\n\n- Narrowing versus broadening of qualifying pathways: the SOP lists discrete medical triggers that can establish a reasonable hypothesis. That creates clearer, testable routes for some claimants but excludes conditions expressly listed as outside the SOP (for example cluster headache, tension‑type headache, familial hemiplegic migraine — see s.7(2)(b)).\n\n- Behavioural effects on clinicians and administrators: clinicians preparing evidence and decision administrators will tailor records and enquiries to the definitions and timeframes the SOP uses (for example seven‑day windows after head injury; five‑year windows for asthma or obesity).\n\n- Interaction with other SOPs and medical classifications: the instrument relies on external clinical standards (ICD‑10‑AM, ICHD‑3) and on other SOPs for related injuries/diseases, which means claim outcomes can turn on cross‑referenced instruments and accepted diagnostic codes (s.7(3)–(4), Schedule 1, s.11).\n\n**Who pays, who decides, and what changes in behaviour**\n\n- Who decides: the RMA issues the SOP; decision‑makers applying the VEA/MRCA use it as the medical standard to determine whether a reasonable hypothesis linking migraine to service exists (s.3, s.5, s.8).\n\n- Who pays: this SOP does not itself create payment; if a decision maker accepts the causal link under the VEA or MRCA framework, entitlements and benefits payable under those Acts (administered by the Department of Veterans' Affairs or MRCA processes) may be paid. The fiscal effect depends on claim acceptance rates and entitlement rules in the Acts (see s.5).\n\n- Behaviour change: claimants and their advisers will focus evidence gathering on the SOP's listed factors and time windows; clinicians may be asked to provide reports tied to the defined criteria; decision makers will apply the SOP as the medical threshold rather than a free‑form causation inquiry.\n\n**Costs, trade‑offs and implementation risks**\n\n- Compliance burden: the need for specific medical evidence (medication records, objective asthma measures, BMI history, head injury timing and loss/regain of consciousness records) can increase documentation costs for claimants and administrative verification costs for the department.\n\n- Bureaucratic discretion and evidentiary gaps: where documentary proof is incomplete (e.g. older BMI records or undocumented inability to obtain care), decision makers will exercise judgment within the \"reasonable hypothesis\" standard — creating some discretion and potential for inconsistent outcomes.\n\n- Concentrated benefits and diffuse costs: the SOP concentrates benefit eligibility on claimants who can meet the enumerated medical factors. The fiscal cost of accepted claims is borne by the compensation system overall; the administrative cost is borne by the Department and the claimant.\n\n- Potential unintended effects: specifying treatment with nitric oxide donors as a qualifying factor could, in limited contexts, affect how such treatments are recorded or prescribed in service settings, but the SOP does not regulate clinical practice — it only recognises the treatment as relevant evidence (s.9(1), s.9(3), Schedule 1 definition of \"nitric oxide donor\").\n\n**Key provisions to look at when preparing or assessing a claim**\n\n- Definition of migraine and exclusions (s.7(2), Schedule 1)\n- The list of qualifying factors and their timeframes (s.9 and Schedule 1 definitions for \"clinical worsening\", \"chronic migraine\", \"severe and persistent asthma\", \"being obese\")\n- Requirement that the factor be related to relevant service (s.10)\n- Cross‑application where other SOPs cover a referenced injury/disease (s.11)\n\n(References in parentheses are to the sections and Schedule of this Statement of Principles.)"},"flash_summary_failed":{"failed":true,"reason":"Unauthenticated. Configure AI_GATEWAY_API_KEY or use a provider module. Learn more: https://ai-sdk.dev/unauthenticated-ai-gateway","source":"analysis-cron"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-migraine-reasonable-hypothesis-no-7-of-2018","history":"/api/acts/statement-of-principles-concerning-migraine-reasonable-hypothesis-no-7-of-2018/history","analysis":"/api/acts/statement-of-principles-concerning-migraine-reasonable-hypothesis-no-7-of-2018/analysis","conflicts":"/api/acts/statement-of-principles-concerning-migraine-reasonable-hypothesis-no-7-of-2018/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-migraine-reasonable-hypothesis-no-7-of-2018/important-cases","documents":"/api/acts/statement-of-principles-concerning-migraine-reasonable-hypothesis-no-7-of-2018/documents"}}