Statement of Principles concerning migraine (Reasonable Hypothesis) (No. 7 of 2018)
made under subsection 196B(2) of the
Veterans' Entitlements Act 1986
Compilation No. 2
Compilation date: 23 March 2020
Includes amendments up to: Amendment Statement of Principles concerning migraine (Reasonable Hypothesis) (No. 15 of 2020) (F2020L00202)
The day of commencement of this Amendment Statement of Principles concerning migraine is 23 March 2020.
About this compilation
This compilation
This 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.
The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.
Uncommenced amendments
The 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.
Application, saving and transitional provisions for provisions and amendments
If 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.
Modifications
If 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.
Self‑repealing provisions
If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.
RMA-Red
Statement of Principles
concerning
MIGRAINE
(Reasonable Hypothesis)
(No. 7 of 2018)
The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.
Section 1 - Statement of Principles concerning migraine (Reasonable Hypothesis) (No. 7 of 2018) - Statement of Principles concerning migraine (Reasonable Hypothesis) (No. 7 of 2018) | Zoe
Dated 22 December 2017
Contents
1 Name
2 Commencement
3 Authority
4 Revocation
5 Application
6 Definitions
7 Kind of injury, disease or death to which this Statement of Principles relates
8 Basis for determining the factors
9 Factors that must exist
10 Relationship to service
11 Factors referring to an injury or disease covered by another Statement of Principles
Schedule 1 - Dictionary
1 Definitions
1 Name
This is the Statement of Principles concerning migraine (Reasonable Hypothesis) (No. 7 of 2018).
2 Commencement
This instrument commences on 29 January 2018.
3 Authority
This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.
4 Revocation
The Statement of Principles concerning migraine No. 56 of 2009, made under subsection 196B(2) of the VEA is revoked.
5 Application
This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004 applies.
6 Definitions
The terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.
7 Kind of injury, disease or death to which this Statement of Principles relates
(1) This Statement of Principles is about migraine and death from migraine.
Meaning of migraine
(2) For the purposes of this Statement of Principles, migraine:
(a) means migraine without aura, migraine with aura (which includes basilar migraine, sporadic hemiplegic migraine and retinal migraine), chronic migraine and vestibular migraine; and
(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.
Note: chronic migraine, migraine with aura, migraine without aura and vestibular migraine are defined in the Schedule 1 – Dictionary
(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).
(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.
Death from migraine
(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.
Note: terminal event is defined in the Schedule 1 – Dictionary.
8 Basis for determining the factors
The 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.
Note: MRCA, relevant service and VEA are defined in the Schedule 1 – Dictionary.
9 Factors that must exist
At 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:
(1) undergoing treatment with a nitric oxide donor, at the time of the clinical onset of migraine;
Note: nitric oxide donor is defined in the Schedule 1 - Dictionary.
(2) having severe and persistent asthma within the five years before the clinical onset of migraine;
Note: severe and persistent asthma is defined in the Schedule 1 - Dictionary.
(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:
(a) injury to the head; or
(b) regaining consciousness following the injury to the head; or
(c) discontinuing medication that impairs the ability to sense or report headache following the injury to the head;
(3) undergoing treatment with a nitric oxide donor, at the time of the clinical worsening of migraine;
Note: clinical worsening of migraine and nitric oxide donor are defined in the Schedule 1 - Dictionary.
(4) having severe and persistent asthma within the five years before the clinical worsening of migraine;
Note: clinical worsening of migraine and severe and persistent asthma are defined in the Schedule 1 - Dictionary.
(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:
(a) injury to the head; or
(b) regaining consciousness following the injury to the head; or
(c) discontinuing medication that impairs the ability to sense or report headache following the injury to the head;
(5) being obese for at least the five years before the clinical worsening of migraine;
Note: being obese and clinical worsening of migraine are defined in the Schedule 1 - Dictionary.
(6) inability to obtain appropriate clinical management for migraine.
10 Relationship to service
(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.
(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.
11 Factors referring to an injury or disease covered by another Statement of Principles
In this Statement of Principles:
(1) if a factor referred to in section 9 applies in relation to a person; and
(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;
then 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.
Schedule 1 - Dictionary
Note: See Section 6
1 Definitions
In this instrument:
being obese means having a Body Mass Index (BMI) of 30 or greater.
Note: BMI is also defined in the Schedule 1 - Dictionary.
BMI means W/H2 where:
W is the person's weight in kilograms; and
H is the person's height in metres.
chronic migraine means a neurological disorder meeting the following diagnostic criteria (derived from ICHD-3):
Headache on greater than 14 days per month for greater than three months, and fulfilling criteria B and C.
Occurring in a patient who has had at least five attacks of any combination of migraine without aura or migraine with aura.
On greater than seven days per month for more than three months, fulfilling any of the following:
criteria C and D for migraine without aura;
criteria B and C for migraine with aura; or
believed by the patient to be migraine at onset and relieved by a triptan or ergot derivative.
Not better accounted for by another ICHD-3 diagnosis.
Note: ICHD-3 is also defined in the Schedule 1 – Dictionary.
clinical worsening of migraine means a change in the nature of the migraine resulting in one or more of the following:
(a) attacks of migraine that are increased in frequency by a factor of two-fold or more;
(b) attacks of migraine that are increased in severity with debilitating, long-lasting symptoms including nausea, vomiting, photophobia or phonophobia;
(c) a conversion from episodic to chronic migraine;
(d) an increase in the requirement for hospitalisation for management of the manifestations or complications of migraine; or
(e) an episode of severe migraine resulting in status migrainosus, cerebral infarct, seizure or death.
Note: chronic migraine is also defined in the Schedule 1 - Dictionary.
ICHD-3 means the International Headache Society: International Classification of Headache Disorders, Third Edition.
migraine—see subsection 7(2).
migraine with aura means a neurological disorder meeting the following diagnostic criteria (derived from ICHD-3):
At least two attacks fulfilling criteria B and C.
One or more of the following fully reversible aura symptoms:
visual;
sensory;
speech and/or language;
motor;
brainstem; or
retinal.
C. At least three of the following six characteristics:
at least one aura symptom spreads gradually over ≥5 minutes;
two or more aura symptoms occur in succession;
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;
at least one aura symptom is unilateral;
at least one aura symptom is positive; or
the aura is accompanied, or followed within 60 minutes, by headache.
D. Not better accounted for by another ICHD-3 diagnosis.
Note 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.
Note 2: ICHD-3 is also defined in the Schedule 1 – Dictionary.
migraine without aura means a neurological disorder meeting the following diagnostic criteria (derived from ICHD-3):
At least five attacks fulfilling criteria B-D.
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.
Headache has at least two of the following four characteristics:
unilateral location;
pulsating quality;
moderate or severe pain intensity; or
aggravation by routine physical activity or causing avoidance of routine physical activity.
During headache at least one of the following:
nausea and/or vomiting; or
photophobia and phonophobia.
Not better accounted for by another ICHD-3 diagnosis.
Note 1: Migraine without aura is also known as common migraine.
Note 2: ICHD-3 is also defined in the Schedule 1 – Dictionary.
MRCA means the Military Rehabilitation and Compensation Act 2004.
nitric 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.
relevant service means:
(a) operational service under the VEA;
(b) peacekeeping service under the VEA;
(c) hazardous service under the VEA;
(d) British nuclear test defence service under the VEA;
(e) warlike service under the MRCA; or
(f) non-warlike service under the MRCA.
Note: MRCA and VEA are also defined in the Schedule 1 - Dictionary.
severe 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:
(a) FEV1 (forced expiratory volume in one second) of 60% or less of expected value;
(b) wheeze, tightness, cough, dyspnoea or other symptoms occurring throughout each day;
(c) frequent flare-ups;
(d) the presence of night-time symptoms on more than one night per week; or
(e) symptoms frequently restrict activity or sleep.
terminal event means the proximate or ultimate cause of death and includes the following:
(a) pneumonia;
(b) respiratory failure;
(c) cardiac arrest;
(d) circulatory failure; or
(e) cessation of brain function.
VEA means the Veterans' Entitlements Act 1986.
vestibular migraine means a neurological disorder meeting the following diagnostic criteria (derived from ICHD-3):
At least five episodes fulfilling criteria C and D.
A current or past history of migraine without aura or migraine with aura.
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.
At least half of episodes are associated with at least one of the following three migrainous features:
headache with at least two of the following four characteristics:
a) unilateral location;
b) pulsating quality;
c) moderate or severe intensity; or
d) aggravation by routine physical activity.
photophobia and phonophobia; or
visual aura.
E. Not better accounted for by another ICHD-3 diagnosis or by another vestibular disorder.
Note: ICHD-3 is also defined in the Schedule 1 – Dictionary.
Note: Endnotes
Note: Endnote 1—About the endnotes
The endnotes provide information about this compilation and the compiled law.
The following endnotes are included in every compilation:
Endnote 1—About the endnotes
Endnote 2—Abbreviation key
Endnote 3—Legislation history
Endnote 4—Amendment history
Abbreviation key—Endnote 2
The abbreviation key sets out abbreviations that may be used in the endnotes.
Legislation history and amendment history—Endnotes 3 and 4
Amending laws are annotated in the legislation history and amendment history.
The 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.
The 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.
Misdescribed amendments
A 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.
If 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.
Note: Endnote 2—Abbreviation key
o = order(s)
ad = added or inserted
Ord = Ordinance
am = amended
orig = original
amdt = amendment
par = paragraph(s)/subparagraph(s)
c = clause(s)
/sub‑subparagraph(s)
C[x] = Compilation No. x
pres = present
Ch = Chapter(s)
prev = previous
def = definition(s)
(prev…) = previously
Dict = Dictionary
Pt = Part(s)
disallowed = disallowed by Parliament
r = regulation(s)/rule(s)
Div = Division(s)
exp = expires/expired or ceases/ceased to have
reloc = relocated
effect
renum = renumbered
F = Federal Register of Legislation
rep = repealed
gaz = gazette
rs = repealed and substituted
LA = Legislation Act 2003
s = section(s)/subsection(s)
LIA = Legislative Instruments Act 2003
Sch = Schedule(s)
(md) = misdescribed amendment can be given
Sdiv = Subdivision(s)
effect
SLI = Select Legislative Instrument
(md not incorp) = misdescribed amendment
SR = Statutory Rules
cannot be given effect
Sub‑Ch = Sub‑Chapter(s)
mod = modified/modification
SubPt = Subpart(s)
No. = Number(s)
underlining = whole or part not
commenced or to be commenced
Note: Endnote 3—Legislation history
Name
Registration
Commencement
Application, saving and transitional provisions
Statement of Principles concerning migraine (Reasonable Hypothesis) (No. 7 of 2018)
3 January 2018F2018L00012
29 January 2018
Amendment Statement of Principles concerning migraine (Reasonable Hypothesis) (No. 98 of 2018)
29 October 2018F2018L01499
26 November 2018
Amendment Statement of Principles concerning migraine (Reasonable Hypothesis) (No. 15 of 2020)
2 March 2020F2020L00202
23 March 2020
Note: Endnote 4—Amendment history
Provision affected
How affected
Subsection 9(2a)………
ad. No. 98 of 2018
Subsection 9(4a)………
ad. No. 98 of 2018
Subsection 7(2)………..
rs. No. 15 of 2020
Schedule 1 – Dictionary – chronic migraine…….
rs. No. 15 of 2020
Schedule 1 – Dictionary – ICHD-3……………….
ad. No. 15 of 2020
Schedule 1 – Dictionary – migraine with aura….
ad. No. 15 of 2020
Schedule 1 – Dictionary – migraine without aura……………….…….