What counts as a prostrating attack?

VA's rating schedule uses the word without defining it. Records that show an attack forced you to stop and lie down, leave work, or seek urgent care describe what the criteria ask about, so keep them along with a headache log.

My headaches started after a head injury in service. Is that enough?

It is the start. The clinician also looks for headache complaints after the injury and a current diagnosis. If VA already connected the head injury, a secondary opinion under 38 CFR 3.310 may fit.

Can my neck condition cause my headaches?

A clinician may consider headaches secondary to a service-connected neck condition when your records show the neck problem came first and the headaches followed.

Do I need a headache diary?

It is not required, but a log of dates, length and what each attack stopped you from doing gives the clinician and VA a clear picture of frequency and severity.

A migraine nexus letter for your VA claim, when a physical cause is in your records

Nexus Letter: $500 flat

Updated October 4, 2026

Commander Health writes migraine nexus letters for VA claims for a flat $500, for headaches with a physical cause in your records, such as a head injury, a neck condition, or blast or noise exposure. A licensed clinician reviews your headache history and service records and signs only if your records support it. If they do not, the clinician declines and you get your money back. It is records only, with no calls or video visits.

What the clinician looks for in your headache records

Migraine claims rest on two things a record has to show: how the headaches behave, and where they came from. For the flat $500, the clinician reviews both.

A diagnosis of migraine or another headache disorder, and notes describing the attacks: how often they come, how long they last, and what they force you to do.
Records of attacks that made you stop what you were doing and lie down, such as urgent care or emergency visits, missed work, or notes that you left duty. VA's rating criteria for migraines ask about prostrating attacks, so these notes matter.
Treatment history: preventive and rescue medications, injections, and how well they worked.
A headache log or diary, if you keep one, and statements from family or coworkers who have seen the attacks.
The physical event in service: a head injury or concussion, a blast exposure, a neck injury, or a documented noise-heavy job, with any treatment notes from the time.
When the headaches started relative to that event, in your own records or statements.

Common service-connection routes for migraines

Direct service connection under 38 CFR 3.303 fits when your service records show the headaches started in service, whether or not anyone called them migraines then.

Secondary service connection under 38 CFR 3.310 has two physical routes a clinician may consider. Headaches can follow a head injury or traumatic brain injury that VA already connected, and headaches can arise from a service-connected neck condition. In both, the records need to show the injury or the neck condition came first and the headaches followed.

Commander Health writes migraine opinions only for a physical cause. If your records show headaches but no clear cause, a nexus letter may still be possible on the direct route; the screen tells you before you pay.

Is there a DBQ for migraines?

Yes. VA's public Headaches (including Migraines) DBQ covers migraines. Commander Health completes it for a flat $200, or with the nexus letter for $550, when your records tie the headaches to a physical cause such as a head injury, a neck condition, or noise or blast exposure. The licensed clinician completes and signs it only when the records also describe how often the attacks come and how they affect you.

If your records do not show a physical cause, Commander Health does not complete the headache DBQ. VA may order its own exam in any case, and VA decides the rating.

What it is not

Physical conditions only: Commander Health does not write PTSD or other mental health opinions, or secondary opinions that run through a mental health condition.
Not an exam or an appointment. There are no calls or video visits; the clinician works from your records, and any follow-up comes by email.
Not a filing service. Commander Health does not file claims and is not a VSO, a law firm, or a VA-accredited representative. Free help filing a claim is available from a VA-accredited Veterans Service Organization.
Not a guarantee. Clinical review never guarantees an outcome. A clinician signs only if your records support the opinion, and VA decides the claim.

Frequently asked questions

What counts as a prostrating attack?: VA's rating schedule uses the word without defining it. Records that show an attack forced you to stop and lie down, leave work, or seek urgent care describe what the criteria ask about, so keep them along with a headache log.
My headaches started after a head injury in service. Is that enough?: It is the start. The clinician also looks for headache complaints after the injury and a current diagnosis. If VA already connected the head injury, a secondary opinion under 38 CFR 3.310 may fit.
Can my neck condition cause my headaches?: A clinician may consider headaches secondary to a service-connected neck condition when your records show the neck problem came first and the headaches followed.
Do I need a headache diary?: It is not required, but a log of dates, length and what each attack stopped you from doing gives the clinician and VA a clear picture of frequency and severity.