How to Get Social Security Disability Benefits for Migraine Headaches
It may be challenging to get long-term Social Security Disability benefits for a diagnosis of migraine headaches, because Social Security cannot “see” your headaches, and typically there are often no objective findings on x-rays or MRI scans that confirm that you have headaches or the severity of those headaches.
In the world of Social Security Disability - it is important to remember that Administrative Law Judges (ALJs) at the hearing level of proving your SSI/SSDI claim find the most compelling evidence often to be that which is "objective" - MRI evidence, Xray evidence, CT scan, and EMG (electromyogram test) and NCS (nerve conduction study) tests - such evidence is there in "black and white" and therefore is not vulnerable to subjective impressions. Proving a claim for disability is driven by the medical record - imagine what might be the opposite of "Perry Mason" moments as far as the ALJ hearing goes.
How to “prove” to Social Security that the headaches that your have are “real” and that they are disabling?
Types of Headaches
There are many types of headaches. The most frequent is a “tension headache.” This is a headache that is caused by muscle spasms in the neck and shoulders that may be brought on by stress or other factors. The trapezius muscles are commonly a cause of tension headaches when they go into spasm, because they attach to the base of the skull. The temples are where the muscles that move the jaw are located, and they can cause tension headaches.
The second most common headache is a migraine headache. Migraines, which are usually throbbing in nature, may occur with or without warning symptoms (which we call an “aura”), such as flashing lights, numbness, or tingling. Hormonal changes, certain foods and drinks, stress, and exercise can trigger a migraine. Nausea and sensitivity to light and sound are frequent symptoms that accompany a migraine.
There are also many other types of headaches, including “cluster” headaches, which are called “cluster” because the attacks occur in clusters, usually at the same time every day or night. The pain is often excruciating and may be located behind one eye, which some patients describe as like a hot poker in the eye.
But whatever the cause of the headaches, those of us who have suffered from headaches know how completely disabling they can be, if they are severe and frequent enough.
Helpful Tips to Getting Disability Benefits
1.) Get a Diagnosis of Your Headaches
There are no objective laboratory tests, x-rays, or imaging studies (such as a brain MRI) that your doctor can use to diagnose your headaches. Your doctor diagnoses your headaches by the symptoms you present. Neurologists are headache specialists, and they are typically the kinds of doctors to go to for a diagnosis.
2.) Document the Severity and Frequency of Your Headaches
Keep a “headache diary.” Write down the day and time that your headache starts and stops; how severe it is (on a 1 to 10 scale); and, how it impairs your functional ability. In other words, during a headache, what can you do and, more importantly, what can you not do? Are you able to sit, stand, walk, lift or carry, or, is the only thing you can do is to lie down and rest until the headache goes away?
If you have nausea, vomiting, vertigo, sensitivity to light and sound, or other symptoms that accompany your headaches, document them in your diary as well and inform your doctor when you see him.
3.) Your Medical Records Must “Prove” You Have Headaches
Because there are no objective laboratory or imaging abnormalities that can “prove” you have headaches, the medical documentation of your headaches by your doctor (preferably a neurologist) is the “proof” that Social Security looks for when they determine whether you have a “severe medical impairment” that may qualify for disability benefits.
Remember, the documentation in the medical records that your doctor enters, and that Social Security looks at, will be only as good as the detailed information you provide to your doctor each time you see him.
4.) Your Medical Records Must Demonstrate Your Headaches Are Disabling
At the risk of being repetitive, just having a “severe medical impairment” (e.g., migraines) is not enough to qualify you for disability benefits, because your doctor must also document your functional impairments (i.e., what you can and cannot do) during the headaches.
A good way to do that is to describe how many hours you must lie down and rest during your headaches.
Keeping a detailed headache diary and bringing it with you each time you see the doctor, will help you to tell the doctor all of the information he needs to enter into your medical records and the information that Social Security will be looking at in deciding whether to award disability benefits.
5.) Go to the Emergency Department or Urgent Care, if you Need to, for Your Headaches
If you have severe enough headaches that require going to the Emergency Department of your hospital or to an Urgent Care Clinic, you should do so. Don't “tough it out.” Not only is it important to get the treatment your condition requires, it is additional “proof” to Social Security that you have severe and disabling headaches, which entitle you to disability benefits.
6.) Keep Regular Follow-Up Appointments and Take Treatments for Your Headaches
You should see your headache doctor regularly and be compliant with the treatments that he prescribes. If you are not seeing your doctor regularly (e.g., monthly visits) and if you are not taking the medications and other treatments that he prescribes for your headaches, then Social Security may determine that your headaches aren't that bad, and that you are not entitled to disability benefits.
7.) Less Than Sedentary RFC
Although the Social Security disability rules are very complicated, the bottom line is that the odds of getting a disability award from Social Security will be better if your doctor can document your ability to work is “less than sedentary” - in the jargon of Social Security Disability, this essentially means that you cannot handle the job duties of a sedentary job (based on inability to concentrate, maintain pace, consistency and focus and excessive breaks/unexcused work absences). In other words, out of an 8-hour workday, this means that your headaches require you to rest, by lying down, taking a break from everything until the headache/migraine has run its course.
9.) Find a Good Doctor
Perhaps easier said than done and according to what can and cannot be accomplished per your specific health care plan. In a perfect world, your doctor should be a doctor who works with and understands headaches (not all doctors do.) He/she should be knowledgeable and willing to help you get the Social Security disability benefits that you deserve.
Disability benefits for chronic headaches/migraines can be difficult
It requires careful and consistent documentation by your doctor of not only your headaches (intensity and frequency), but how they impair your ability to function.
Whether you qualify for disability may depend on your age, educational level, prior work history, transferrable skills, and other factors. However, if your headaches prevent you from doing even a desk job (“less than sedentary”), and your doctor has consistently documented this, then your chances of getting a Social Security disability award will be much better.
SSA utilizes the term "Impairments" (and resulting "limitations" - why you cannot work) are the essential bits of information that must be clearly and consistently documented throughout your medical history by the treating sources (medical doctors, psychologists, psychiatrists).
SSA additionally utilizes the term "Residual Functional Capacity" (RFC); this is a key concept related to the resulting physical and/or mental impairments from conditions for which the disability claim is based upon and the impact upon ability to work.
SSA has its own forms that are used for Physical RFC here and for Mental RFC here. These forms can be filled out by the treating source who has the opportunity to examine the patient and understand the limitations which result from his/her condition and thereby document with specificity in the language of SSA disability.
National Institutes of Health (NIH)
Johns Hopkins Medical Center
American Academy of Neurology