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Understanding the VA Tension Headaches Rating System

October 30, 2023

For veterans, dealing with the aftermath of serving in the military can often lead to various health issues, including tension headaches. These headaches can be debilitating, affecting daily life and overall well-being. To help veterans receive the necessary support, the Department of Veterans Affairs (VA) has established a rating system for assessing the severity and impact of tension headaches.

Understanding the VA tension headaches rating system is crucial for veterans seeking compensation and access to appropriate healthcare services. This article will delve into the intricacies of the rating system, clarifying how it works and what veterans need to know to navigate through the process effectively. Whether you are a veteran experiencing tension headaches or an advocate seeking information for a loved one, this guide aims to provide clarity and enable you to make informed decisions regarding VA benefits.

VA Rating Criteria for Tension Headaches

“Tension headaches in veterans are rated by frequency, duration, and severity based on the VA's Schedule for Rating Disabilities.”

For tension headaches, these ratings primarily consider three dimensions of the condition: frequency, duration, and severity of the headache episodes.

  • 0% Rating: A 0% rating is typically assigned when a veteran's tension headaches are documented but are either infrequent or do not significantly impact their normal work routine and social functioning. While this rating acknowledges the presence of the condition, it does not provide monthly compensation since the headaches are not seen to impact the veteran’s life substantially.

  • 10% Rating: This rating is given when a veteran experiences headaches more frequently. At this level, the headaches may be somewhat limiting, but they do not completely interfere with the ability of a veteran to function normally. They may be episodic, with the veteran still able to manage most activities of daily living.

  • 30% Rating: For a 30% rating, the tension headaches must be shown to cause a greater level of disability. This might mean that the headaches occur frequently and with an intensity that causes a considerable impact on the veteran’s ability to work or engage in social activities. The headaches at this level may require rest periods during the day, but they do not completely incapacitate the individual.

  • 50% Rating: The highest rating for tension headaches is 50%. This rating is reserved for the most severe cases, where the headaches are so frequent, prolonged, and severe that they lead to significant prostration—meaning the veteran is forced to lie down during an attack. These headaches typically occur several times per month and are debilitating to the point that the veteran’s ability to work and engage in social relationships is severely compromised.

Causes of Tension Headaches

The occurrence of tension headaches in veterans can stem from a complex interplay of physical and psychological factors. Understanding these triggers is key to both treatment and the VA's evaluation of disability claims.

Stress and Anxiety as a Trigger

Stress and anxiety are widely recognized as common triggers for tension headaches. The demands of military service, exposure to combat, and the stress of transitioning back to civilian life can contribute to a veteran's psychological burden, potentially leading to recurrent tension headaches. 

Notably, in the post-9/11 era, a significant proportion of combat veterans experience tension headaches, with studies indicating that over 20% of these individuals report symptoms consistent with this condition1.

Poor Posture as a Trigger

Poor posture can strain the muscles of the neck and back, leading to the muscle tension that characterizes this type of headache. Service-related activities, such as carrying heavy equipment or maintaining the same position for extended periods, can contribute to developing poor postural habits that continue post-service. 

The VA assesses whether service-connected musculoskeletal injuries, which may force a veteran into compensatory postural adjustments, are a contributing factor to the development of chronic tension headaches.

Diet and Lifestyle Choices as Triggers

Lifestyle choices, including diet, hydration, sleep patterns, and exercise habits, have a substantial impact on the well-being of veterans and can be triggers for tension headaches. A lifestyle that lacks regular physical activity, features poor nutritional choices, or includes irregular sleep can heighten the risk of tension headaches. 

The VA acknowledges the role that such service-related lifestyle factors might play in tension headache disorders, particularly when veterans have difficulty adopting healthier routines after leaving the service environment.

Medication-Induced Tension Headaches

Medication-overuse headaches, also known as rebound headaches, are another potential cause of tension-type headaches. This can occur when pain medication, taken frequently for chronic service-related injuries or conditions, leads to a paradoxical increase in headache frequency and severity.

Symptoms of Tension Headache Disorder

The symptoms associated with tension headache disorder are diverse and can significantly influence the VA tension headaches rating due to their impact on a veteran's functionality.2

Pain Intensity and Frequency3311

The intensity of the pain can vary from mild to severe and is often described as a constant, dull ache. When evaluating tension headaches for disability ratings, the VA considers the degree to which the pain affects a veteran’s ability to function normally. Frequent episodes of intense pain that interfere with daily tasks, work, and quality of life can lead to a higher disability rating. 

The frequency of these episodes is particularly relevant; for example, veterans who experience tension headaches more than 15 days per month may be considered for a higher rating than those with less frequent episodes.

Duration of Painful Episodes

The VA also examines the duration of the headaches. Shorter episodes may not impact a veteran’s lifestyle to the same extent as longer-lasting ones. For a higher disability rating, the VA looks for a pattern of prolonged episodes. Tension headaches that persist for hours or even days at a time can significantly disrupt a veteran's routine, including their ability to maintain employment and social relationships.

Associated Symptoms (e.g., Nausea, Vomiting, etc.)

Although tension headaches are usually not associated with symptoms such as nausea or vomiting, their presence could suggest a more complex or severe headache disorder. If these symptoms are reported and attributed to the tension headaches, the VA may adjust the disability rating to account for the additional severity and the further limitation on the veteran's capabilities. Veterans need to document all associated symptoms when seeking medical attention, as this information is vital in the VA’s evaluation process.

Diagnosing a Tension Headache Disorder

“Accurately diagnosing a tension headache disorder can pave way for the much needed benefits and relief”

Diagnosing a tension headache disorder requires a careful and comprehensive approach, particularly within the context of the VA, as it can influence a veteran's entitlement to benefits.

Medical Examination

During the medical examination, healthcare providers assess the nature and characteristics of the headaches. They look for specific features that define tension headaches, such as bilateral pain (affecting both sides of the head), a pressing or tightening quality (non-pulsating), and the absence of significant nausea or vomiting. The pain should not be worsened by routine physical activity, such as walking or climbing stairs.

Medical History Review

The review of the veteran's medical history is also pivotal. Practitioners consider the onset, duration, and frequency of the headaches. They gather information on any previous treatments and responses to those treatments, which can provide insights into the chronicity and severity of the condition.

Service Connection

To establish a service connection, the VA will evaluate the veteran’s reported triggers and lifestyle factors that may link the tension headaches to service. For example, if a veteran began experiencing headaches after a particular event in service or if headaches became significantly worse during or after service, this may be considered evidence of a service connection. The presence of stressors or injuries that occurred during military service that could reasonably be considered triggers for tension headaches would also be relevant to the diagnosis and rating.

Additional Diagnostic Criteria

The VA may require documentation that the veteran has sought routine care for tension headaches, which helps to rule out other potential causes of the headaches. The presence of at least ten previous episodes of headaches is typically required for consideration of a compensable rating, and these episodes must meet certain criteria in terms of duration (lasting from 30 minutes to 7 days) and not attributable to another disorder.

Exclusion of Other Disorders

Healthcare providers also ensure that another headache disorder or a different medical condition does not better account for the symptoms. This may involve ruling out migraine headaches, cluster headaches, or secondary headaches that could be symptoms of another underlying issue, such as a head injury or other neurological conditions.

Treatment Options for Chronic Tension Headaches

Treatment for chronic tension headaches is often multifaceted to reduce both the frequency and severity of headaches.3 The VA provides a range of treatment options to help veterans manage this condition effectively.


The foundation of treatment may involve the use of preventive medications. These can include antidepressants, which are commonly used in low doses to help prevent tension headaches; antiepileptic drugs, which have been found to be effective in some cases; and muscle relaxants. 

For immediate relief during a headache episode, over-the-counter pain relievers like ibuprofen or acetaminophen may be recommended. It is important to use these medications appropriately to avoid overuse, which can lead to rebound headaches.

Stress Management Techniques

Given the significant role stress plays in triggering tension headaches, stress management is often a key component of treatment. The VA may offer counseling services, cognitive-behavioral therapy (CBT), biofeedback, and relaxation techniques such as meditation or deep-breathing exercises. These strategies help veterans learn to control their stress responses and may reduce the occurrence of headaches.

Physical Therapy

Physical therapy can be especially beneficial for veterans with tension headaches. Therapists may employ various techniques, including massage, stretching exercises, and posture training, to address muscle tension in the neck and shoulders that can contribute to headaches.

Lifestyle Adjustments

Lifestyle modifications are also a critical part of managing chronic tension headaches. This could involve establishing regular sleep patterns, improving diet and hydration, incorporating regular physical activity, and teaching proper ergonomics to reduce strain on the body. The VA encourages veterans to make these healthy changes, which can improve overall wellbeing and potentially decrease the frequency of headaches.

Alternative and Complementary Therapies

In addition to conventional treatments, some veterans may find relief through alternative therapies such as acupuncture, chiropractic care, or herbal supplements. The VA may provide access to these types of treatments or offer referrals to specialists who can administer them.

Patient Education

Educating veterans about their condition is another aspect of treatment. This includes informing them about potential triggers, how to use medications properly, and when to seek medical attention. The VA may offer classes or resources to help veterans understand and manage their symptoms more effectively.

Continual Evaluation and Support

Since chronic tension headaches can affect veterans' quality of life, it is essential for healthcare providers to continually evaluate the effectiveness of the treatment plan and make adjustments as necessary. Support groups or peer counseling provided by the VA can also be an invaluable resource, offering veterans a community of individuals with similar experiences.

Navigating the VA Rating System for Tension Headaches

In conclusion, understanding the VA tension headaches rating system is vital for veterans seeking disability compensation. Proper documentation of symptoms, frequency, and triggers is crucial in obtaining an accurate rating. Veterans are encouraged to seek assistance from VA representatives or veterans service organizations to navigate the claims process successfully.

Are you navigating life with a 100% VA disability rating but still capable of employment? Discover how you can manage work while receiving your full benefits in this guide.

Michael Blair contributes his expertise to help veterans access government benefits and resources. Through his informative articles and guides, he plays a vital role in empowering veterans and improving their quality of life.
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