SSA Issues Migraine Guidance

March 11, 2010

Author: Catherine M. Callery (Kate) | Louise M. Tarantino

Trying to prove disability based on headaches, particularly migraine headaches, can definitely cause headaches.  Since migraine headache is usually a “rule out” diagnosis, by definition there will be a dearth of objective evidence. The claim will be based primarily on subjective symptoms. 

The Social Security Administration (SSA) recently addressed some of these issues in response to questions posed by adjudicators.  Q&A 09-036, which is found on SSA’s intranet at http://policynet.ba.ssa.gov but is not available to the public, updates previous guidance from the Office of Disability from the early 1990s.  SSA acknowledges in the Q&A that despite significant changes in the diagnosis and treatment of migraine headaches since that time, there is little change in the guidance provided.

SSA reiterates in Q&A 09-036 that migraines cannot be considered a “medically determinable impairment” (MDI) solely on a diagnosis or reported symptoms.  There must be clinical signs or laboratory findings.  Once other possible causes have been ruled out by laboratory findings, migraines can be established as an MDI based on “signs” reported by a physician if accompanied by detailed descriptions of the headache event, which is defined as an “intense headache with more than moderate pain and with  associated migraine characteristics and phenomena.”

The Q&A lists the detailed descriptions that should accompany a diagnosis of a migraine headache: premonitory symptoms, aura, duration, intensity, accompanying symptoms, and effects of treatment. Other acceptable indicators include a headache event that lasts from four to 72 hours if untreated or unsuccessfully treated, with two of the following: unilateral, pulsating (throbbing) quality; moderate (inhibits but does not wholly prevent usual activity) or severe (prevents all activity) pain intensity, worsened by routine physical activity (or causing avoidance of activity); and at least one of the following: nausea, vomiting, photophobia or phonophobia.

SSA emphasizes that migraine headaches will rarely be considered a disabling condition.  Listing 11.03 for nonconvulsive epilepsy is the most analogous listing. The Q&A reviews those components of Listing 11.03 as they may be related to migraine headaches.  SSA warns adjudicators, however, that the guidance in POMS DI 24580.001/SSR 87-06 is specific to epilepsy and not applicable to migraines. Nor do issues of noncompliance based on therapeutic blood levels apply, since there is no comparable standard of case for migraines.

The Q&A is available as DAP #523.  If it causes more headaches, take two aspirin and don’t call us in the morning.