HEADACHE / MIGRAINE DEVELOPMENT WORKSHEET

Issue:
Diagnosis if known:
Claim lane: direct / secondary / increase / supplemental / HLR / Board / not sure

Onset:
When did headaches start:
What was happening then:
In-service event, exposure, TBI/head injury, neck issue, stressor, sleep issue, sinus issue, or other theory:

Pattern:
Frequency:
Duration:
Severity 0-10:
Worst days:
How often must you stop activity or lie down:
Dark/quiet room needed? yes / no / sometimes

Associated symptoms:
- nausea
- vomiting
- light sensitivity
- sound sensitivity
- aura / visual changes
- dizziness
- cognitive fog
- tinnitus / ringing
- weakness
- speech difficulty
- fatigue
- other:

Work / economic impact:
Missed work:
Reduced productivity:
Schedule changes:
Unsafe driving:
Lost opportunities:

Household / social impact:
Chores:
Family events:
Social events:
Errands:
Exercise:
Sleep:

Treatment:
VA treatment:
Private treatment:
Medications:
ER/urgent care:
Headache diary exists? yes / no

Secondary theory clues:
- neck/cervical spine
- TBI/head injury
- PTSD/stress
- sleep apnea/sleep disruption
- sinus/rhinitis
- tinnitus/noise sensitivity
- medication side effects
- hypertension
- other:

Witnesses:
Who has observed attacks or impact:
What they personally saw:
BuddySign needed? yes / no / not sure

Top evidence gaps:
1.
2.
3.

Prompt to use:
I am developing a VA disability claim for headaches or migraines. Interview me one question at a time. Help me document onset, frequency, duration, severity, attacks that force me to stop activity or lie down, missed work, reduced productivity, household impact, social impact, associated symptoms, triggers, medication history, treatment history, and possible direct or secondary service-connection theories. Do not invent facts. After the intake, tell me what evidence I have, what evidence is missing, and what I should develop next.
