{"id":"F2018L00564","name":"Statement of Principles concerning tension-type headache (Balance of Probabilities) (No. 38 of 2018)","slug":"statement-of-principles-concerning-tension-type-headache-balance-of-probabilities-no-38-of-2018","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439612,"registerId":"F2018L00564-fast-fetch-1775955571520","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning tension-type headache (Balance of Probabilities) (No. 38 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\nTENSION-TYPE HEADACHE (Balance of Probabilities)\n\n(No. 38 of 2018)\n\nThe Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n \n\nDated 27 April 2018\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:
|\n| --- |\n| 
Professor Nicholas Saunders AO
Chairperson
|\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\n\n\n\n1 Name\n\nThis is the Statement of Principles concerning tension-type headache (Balance of Probabilities) (No. 38 of 2018).\n\n2 Commencement\n\n This instrument commences on 28 May 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 tension-type headache No. 2 of 2010 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 tension-type headache and death from tension-type headache.\n\nMeaning of tension-type headache\n\n(2) For the purposes of this Statement of Principles, tension-type headache:\n\n(a) means a condition in which within a 12 month period, there are episodes of headache lasting at least 30 minutes, occurring on at least one day per month for at least three consecutive months, and a minimum of ten episodes occur within that 12 month period; and\n\n(b) has at least two of the following characteristics:\n\n(i) bilateral location;\n\n(ii) pressing/tightening (nonpulsating) quality;\n\n(iii) mild or moderate intensity;\n\n(iv) not aggravated by routine physical activity (such as walking or climbing stairs); and\n\n(c) causes clinically significant distress or impairment of social, occupational, educational, or other important areas of functioning; and\n\n(d) excludes:\n\n(i) cluster headache; \n\n(ii) migraine;\n\n(iii) headache attributable to structural abnormalities or inflammatory disorders of the head and neck;\n\n(iv) headache attributable to systemic disease; and\n\n(v) headache that results from normal physiological stress such as exercise, or the temporary effect of extraneous agents.\n\n(3) While tension-type headache attracts ICD‑10‑AM code G44.2, in applying this Statement of Principles the meaning of tension-type 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 tension-type headache\n\n(5) For the purposes of this Statement of Principles, tension-type headache, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's tension-type headache.\n\nNote: 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 tension-type headache and death from tension-type headache can be related to relevant service rendered by veterans 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 exist before it can be said that, on the balance of probabilities, tension-type headache or death from tension-type headache is connected with the circumstances of a person's relevant service:\n\n(1) for chronic tension-type headache in migraine and cluster headache sufferers only, taking a drug as specified, for at least the three months before the clinical onset of tension-type headache;\n\nNote: chronic tension-type headache and taking a drug as specified are defined in the Schedule 1 - Dictionary. \n\n(2) taking a drug as specified, for at least the three months before the clinical worsening of tension-type headache;\n\nNote: taking a drug as specified is defined in the Schedule 1 - Dictionary. \n\n(3) undergoing treatment with a nitric oxide donor, at the time of the clinical worsening of tension-type headache;\n\nNote: nitric oxide donor is defined in the Schedule 1 - Dictionary. \n\n(4) inability to obtain appropriate clinical management for tension-type 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(2) to 9(4) apply only to material contribution to, or aggravation of, tension-type headache where the person's tension-type 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(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\n \n\n \n\nSchedule 1 - Dictionary \n\nNote: See Section 6\n\n1 Definitions\n\nIn this instrument:\n\n chronic tension-type headache means tension-type headache that lasts for hours or may be continuous, occurring on at least 15 days per month on average, for more than three months.\n\n combination analgesic medication means medication containing a simple analgesic combined with an opioid, butalbital or caffeine.\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n nitric oxide donor means a pharmacologically active substance that releases nitric oxide in vivo or in vitro and includes amyl nitrate, glyceryl trinitrate, isosorbide mononitrate, isosorbide dinitrate, sodium nitroprusside, mannitol hexanitrate and nitrous oxide.\n\n relevant 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\nNote: MRCA and VEA are also defined in the Schedule 1 - Dictionary.\n\n taking a drug as specified means:\n\n(a) taking a simple analgesic on at least three days per week; or\n\n(b) taking a triptan, ergotamine, an opioid, or a combination analgesic medication on at least two days per week.\n\nNote: combination analgesic medication and triptan are also defined in the Schedule 1 – Dictionary.\n\n tension-type headache—see subsection 7(2).\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 triptan means a 5-hydroxytryptamine receptor agonist.\n\n VEA means the Veterans' Entitlements Act 1986.\n\n \n\n \n","sortOrder":0}],"analysis":{"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument expressly revokes the 2010 Statement (s4) and replaces it (Name, s1). It restates and narrows the clinical definition of tension‑type headache with specified episode frequencies and symptom criteria (s7(2)), adds defined contributory factors including quantified drug‑use thresholds and nitric oxide donor exposure (s9; Schedule), and includes death from a terminal event contributed to by the condition (s7(5); Schedule). It applies to claims under VEA s120B or MRCA s339 (s5)."},"complexity_factors":["Clinical diagnostic thresholds requiring episode frequency, duration and symptom characteristics (s7(2)) increase medical-evidence detail.","Explicit inclusion of death via contribution to a terminal event broadens causal pathways that must be considered (s7(5); Schedule: terminal event).","Quantified drug‑use thresholds for causation/ aggravation (Schedule: 'taking a drug as specified') require medication histories with frequency data.","Specific named pharmacological exposures (nitric oxide donors listed in Schedule) create discrete exposure rules (Schedule; s9(3)).","Conditional application tied to timing of onset vs. service (material contribution/aggravation only where pre‑existing condition was 'before or during' service) adds temporal complexity (s10(2)).","Cross‑reference to other Statements of Principles means determinations can depend on other instruments and their current terms (s11).","Application is limited to claims under particular statutory provisions (VEA s120B or MRCA s339), so operational scope is legally constrained (s5).","Revocation of the 2010 Statement requires comparing old and new criteria for legacy claims assessment (s4)."],"plain_english_summary":"This instrument sets the medical test for when tension‑type headache (and death where headache contributed) can be treated as connected to Australian military service for claims under the VEA and MRCA. It defines a clinical case definition, lists specific service‑related factors (notably quantified patterns of drug use, exposure to nitric oxide donors, and inability to obtain appropriate care), and replaces the earlier 2010 Statement. It matters to veterans and decision‑makers because it determines which medical histories and exposures count as service‑related."},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This instrument appears to be a straightforward replacement/update of a previous Statement of Principles (No. 2 of 2010). It maintains the standard structure and purpose of Repatriation Medical Authority determinations under section 196B(3) of the VEA. The scope remains limited to establishing medical criteria for determining service connection for tension-type headaches, which is the original and continuing purpose of such instruments."},"complexity_factors":["Multiple nested definitions requiring cross-referencing (e.g., 'taking a drug as specified' refers to 'combination analgesic medication' and 'triptan', which are separately defined)","Conditional logic with temporal requirements (e.g., 'for at least the three months before the clinical onset', 'at the time of the clinical worsening')","Specific exclusion criteria in the disease definition (5 categories of excluded headache types)","Dual legislative framework application (VEA and MRCA with different service categories)","Section 10 creates a distinction between onset during service versus aggravation of pre-existing condition","Factor 9(1) has a limiting qualifier ('in migraine and cluster headache sufferers only') that restricts its application","Cross-reference to external medical classification system (ICD-10-AM Tenth Edition with specific ISBN)","Section 11 creates dynamic incorporation of other Statements of Principles by reference"],"plain_english_summary":"The rulebook sets the medical criteria the Department of Veterans’ Affairs uses to decide if tension‑type headaches are service‑connected for compensation under the Veterans’ Entitlements Act and the Military Rehabilitation and Compensation Act. It defines the condition, applies the balance‑of‑probabilities legal standard, and guides clinical and adjudicative assessment.\n\nIt affects veterans and current/former defence members, treating clinicians, and DVA decision‑makers. Claims must show the headaches are linked to service—commonly via certain treatments or lack of care—with medication‑related rules limited to onset or worsening 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-tension-type-headache-balance-of-probabilities-no-38-of-2018","history":"/api/acts/statement-of-principles-concerning-tension-type-headache-balance-of-probabilities-no-38-of-2018/history","analysis":"/api/acts/statement-of-principles-concerning-tension-type-headache-balance-of-probabilities-no-38-of-2018/analysis","conflicts":"/api/acts/statement-of-principles-concerning-tension-type-headache-balance-of-probabilities-no-38-of-2018/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-tension-type-headache-balance-of-probabilities-no-38-of-2018/important-cases","documents":"/api/acts/statement-of-principles-concerning-tension-type-headache-balance-of-probabilities-no-38-of-2018/documents"}}