It's not easy to qualify for disability benefits based solely on migraine headaches, but you can get approved if you have a well-documented history of persistent, severe migraines that substantially interfere with your daily life.
Migraines: Diagnosis and Treatment
A migraine is a neurological condition marked by intense headaches sometimes accompanied by nausea, vomiting, and perceptual disturbances known as aura. An aura may proceed a migraine headache by several minutes or even hours, and it often manifests itself visually, as a set of zigzag lines or bright spots. Tunnel vision and blind spots are also typical, as are photophobia and phonophobia (light and sound intolerance). The pain associated with a migraine can be debilitating; many people are left with little choice but to lie down in a dark room and wait for the headache to pass.
Physicians base a migraine diagnosis primarily on reported symptoms and medical history. Although migraines do not appear on x-rays or MRIs, objective testing may be useful in ruling out other possible causes of headache, such as multiple sclerosis or fibromuscular dysplasia.
Many doctors suggest keeping a headache diary and recording detailed information about your headaches, including the following:
- date of migraine
- length of migraine
- intensity of pain
- description of aura, if any
- preceding symptoms
- possible triggers
- medication and dosage, and
- level of relief.
You should be able to obtain a headache diary from your physician or even construct a simple one yourself. Keeping a journal will assist your doctor in making an accurate diagnosis. It will also improve your Social Security disability case by documenting to the extent possible the frequency and intensity of your migraines.
If you have several migraines per month, your doctor may prescribe beta blockers, antidepressants, or anti-seizure drugs to try to reduce the occurrence of headaches. Medications known as triptans are used to alleviate migraine symptoms, but won't prevent migraines. Imitrex (sumatriptan) might be the best-known example.
One way to tell a migraine headache from an ordinary one is to see whether a triptan medication provides relief. Because triptans are not ordinary pain relievers but are specifically designed to treat migraines, a headache effectively treated with a triptan is likely a migraine. The reverse is not the case: headaches unrelieved by triptans may still be migraines.
Migraines and Social Security's Blue Book
SSA's "Blue Book" Listing of Impairments contains hundreds of medical conditions that will automatically medically qualify a person for disability benefits. There is no listing specifically for migraines in Social Security's Blue Book, so a person who suffers only from migraines will not meet a listing. However, migraine headache sufferers may "equal" a listing if it can be shown that their symptoms are of equal severity to a listing for a similar condition.
Because the latest medical research places migraines on the seizure spectrum, it's possible that someone with chronic migraines could equal the listings epilepsy. Merely having occasional migraines won't equal the listing. Migraines must occur at least twice a week, despite treatment, and impair mental functioning for several hours at a time. While it's quite difficult to equal the epilepsy (or any other) listing with migraines, your chances will be improved if your doctor provides an opinion that the limitations caused by your migraines are as severe as the limitations specified in the epilepsy listings. (See Nolo's article on the disability listings for epilepsy.)
Receiving a Medical-Vocational Allowance for Migraines
Even if your condition doesn't meet or equal a listing, you may still be approved for disability benefits through a "medical-vocational allowance." This is, in fact, the most common path to receiving disability benefits. In determining whether you qualify, Social Security takes into account your age, educational level, employment history, and Residual Functional Capacity (RFC) to decide whether there are jobs that exist in the U.S. that you can perform.
Your RFC is the most you can do in spite of all your impairments. One or more of the following limitations might be found in the RFC of a person with persistent migraines.
- Would miss more than two days of work per month due to pain.
- Would be off-task for at least 15% of the workday due to pain.
- Would be unable to maintain focus and concentration throughout the workday, and/or
- Would require unscheduled breaks throughout the day because of nausea, pain, or the side effects of medication.
Ask your doctor to provide a written opinion as to whether you experience any or all of the above limitations. Better yet, ask your doctor to fill out a Residual Functional Capacity form. In addition to opinion evidence from the doctor who regularly treats you, Social Security will expect to see your doctor's notes regarding the frequency and severity of your headaches, the results of attempted treatments, and records from any related visits to the hospital. The more you can document your migraines, the better your chances with Social Security.