Can You Get Disability for Migraines or Cluster Headaches?

Migraine headaches, or chronic migraines, are neurologically based headaches that often include symptoms such as pain, nausea, vomiting, and increased sensitivity to light and sound. Migraines can range in severity from mild to debilitating and can last anywhere from 4 to 72 hours, sometimes longer. Cluster headaches are a related disorder where shorter headaches lasting between 15 minutes and three hours occur several times a day—frequently around the same time every day—often coming at night, an hour or two after you've gone to bed.

Getting Social Security disability benefits for migraines or other headache disorders can be a challenge. In recent years, however, the Social Security Administration (SSA) has expanded its methods of evaluating disability claims for migraines as a response to medical advances. Knowing what the SSA needs to see in terms of diagnostic criteria can help you strengthen your medical records and increase your chances of success.

Are Chronic Migraines a Disability?

Occasional migraines may be nothing more than an inconvenience, but those who experience regular, severe headaches can find it very difficult to function on a daily basis. People with chronic migraines often find that they're unable to do anything besides staying in bed in a dark room for hours or even days at a time. Medications might not always be effective, and even when they offer some relief, they can sometimes have serious side effects—like dizziness or drowsiness—that can interfere significantly with your daily activities.

If you have chronic migraines or cluster headaches that keep you from working full-time for at least twelve months despite treatment, you may be eligible for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI).

Collecting Social Security Disability for Migraines or Cluster Headaches

You can qualify for disability benefits in one of two ways—by establishing that your headache disorder meets or equals a "listed impairment" or by showing that your headaches cause work restrictions that rule out all jobs. If Social Security finds the answer to either of these questions is yes, then you'll qualify medically for disability benefits. You'll also need to meet some preliminary legal criteria to collect SSDI or SSI, which you can learn about in our article on non-medical requirements for Social Security disability benefits.

Social Security's Blue Book and Chronic Migraines

The surest way to prove your disability case is to meet the requirements of a disorder in the Blue Book. The Blue Book is a list of medical conditions that the SSA considers to be potentially automatically disabling. If your chronic migraines are caused by another medical impairment (like a traumatic brain injury) you'll need to meet the listing requirements for that condition.

Unfortunately, the SSA doesn't currently have a disability listing specifically for headache disorders like migraines. But, you might still be able to show that your chronic migraines or cluster headaches—whether alone or in combination with another condition—equal a listing. According to Social Security Ruling 19-4p, Evaluating Cases Involving Primary Headache Disorders, you may equal listing 11.02 for epilepsy if your chronic migraines limit your ability to function as much as the listing's requirements for dyscognitive seizures.

This means that you must show that despite following your doctor's prescribed treatment you still have migraines at least once a week for at least three consecutive months. Alternatively, you can show that (even with medical treatment) your headaches occur at least once every two weeks for three consecutive months and cause severe limitations in at least one of the following areas:

• physical functioning (such as standing or balancing)
• understanding and using information
• interacting with others, like co-workers and supervisors
• concentrating on and completing tasks quickly, or
• adapting to change or managing your emotions and taking care of yourself.

Your case will be much stronger if your doctor writes a supportive medical opinion describing the frequency and severity of your headaches and stating that your chronic migraines are as disruptive and limiting as the seizures in the SSA's epilepsy listing.

Getting a Medical-Vocational Allowance for Migraines or Cluster Headaches

Even if you don't equal the listing for epilepsy, you can still get disability if your migraines or cluster headaches cause functional limitations that keep you from performing any full-time job. To determine whether you can work, Social Security will review your medical records and daily activities in a process known as assessing your residual functional capacity (RFC).

What's In Your RFC? Your RFC is a set of restrictions reflecting the most you're capable of doing in a work environment despite your migraines or cluster headaches. Depending on how severe your headaches are, your RFC will likely contain limitations in your ability to focus, follow instructions, interact with others, work with dangerous equipment or at heights, maintain attendance, and complete tasks at a reasonable pace.

Any limitations, both physical and mental, that are documented in your medical records must be included in your RFC, so the agency will also take into account any other conditions you have that further limit your ability to work (for example, if you have a shoulder injury that prevents you from lifting heavy items).

How Is Your RFC Used? Social Security will compare the restrictions in your current RFC with the demands of your past work to see whether you could do that job today. If you can't perform your previous jobs, the agency will then need to determine whether any other work exists that you can do despite the limitations in your RFC. You must be unable to perform both your old work and any other work in the national economy before your claim can be approved.

For disability claimants under the age of 50, this typically means that you'll need to show that you can't do even the simplest sit-down jobs on a regular basis. If you're 50 years of age or older, you may have an easier time qualifying for disability under a special set of rules called the "medical-vocational grid." The grid uses additional factors such as your education and skill set to determine whether you could transition to other types of work before you hit full retirement age.

What Medical Evidence Do You Need to Get Disability for Migraines or Cluster Headaches?

Your medical records are the foundation of your disability claim, so it's critical that you've received regular treatment for your migraines or cluster headaches. This is true whether you believe you meet the requirements for a listing or you're seeking a medical-vocational allowance. Objective medical evidence carries the most weight with the SSA, although your subjective symptoms are important as well.

Medical Records to Establish Your Migraine or Cluster Headache Diagnosis

Social Security will want to see a diagnosis in your medical records. Specifically, the agency will look to see that your doctor has diagnosed you with "recurrent migraine headaches." Although there's no definitive test to diagnose migraines or cluster headaches, they can often be diagnosed based on your reported symptoms and a family history of migraines.

Your doctor may have ordered tests such as an MRI or CT scan to rule out other reasons for your headaches (a "differential diagnosis"). To help establish a diagnosis, your medical records should contain the following:

• clinical notes from your doctor's visits regarding the frequency and severity of your migraines
• medication lists or other treatments you've tried as well as any side effects, and
• records from any ER visits or hospitalizations related to your migraines.

Social Security might also ask your doctor to complete a report or questionnaire regarding your headache disorder. In some cases, the agency will also seek input from family members or friends who see you frequently.

Evidence Showing Symptoms of Cluster Headaches or Migraines

Because part of the disability determination process involves figuring out what limitations you have that restrict your functioning, the SSA will need to see documentation of your symptoms. While they can vary somewhat from person to person, there are common symptoms that the agency will be on the lookout for.

Migraine symptoms can be classified into several phases: a "prodromal" stage occurring one to two days before the migraine, an "aura" immediately prior to onset of the migraine, the "attack" (actual headache), and the "postdromal" stage after the headache subsides.

• Prodromal symptoms can cause subtle changes in your body such as mood shifts, constipation, food cravings, neck stiffness, increased urination, fluid retention, and frequent yawning.
• Auras may manifest as visual phenomena like bright spots or jagged lines, a pins-and-needles sensation in the arms and legs, weakness or numbness in the face, or difficulty speaking.
• A migraine attack typically consists of severe throbbing head pain, often accompanied by nausea, vomiting, and sensitivity to light and noise.
• During the postdromal period, which can last for up to one day, you might feel drained of energy, tired, or confused.

Common symptoms of cluster headaches include:

• intense pain on one side of your head that may radiate to other areas of your face, head, and neck
• pain concentrated in, behind, or around one eye
• affected eye tears up and can become red or swollen
• eyelid droops, nasal symptoms, or facial symptoms on the affected side, and
• feeling restless or feeling the need to pace or rock in place.

Many claimants with headache disorders find it helpful to keep a diary or journal where they keep track of the frequency, duration, and intensity of their headaches. You should bring this with you to your doctor's appointments so that it can become part of your disability record.

Treatment for Migraines and Cluster Headaches

The SSA will want to know which treatments you've tried to reduce the number or severity of your migraines—it's very unlikely that your claim will be approved if you haven't tried several different medications or therapies to treat your chronic migraine headaches. Treatment for migraines usually involves medications such as:

• over-the-counter pain relievers such as Advil or Motrin IB for milder migraines
• triptans, a class of prescription medications (such as Imitrex or Maxalt) that block pain pathways in the brain
• dihydroergotamine (also called Migranal or Trudhesa) for migraines lasting longer than 24 hours
• oral calcitonin gene-related peptides antagonists ("gepants"), such as Ubrelvy or Nurtec ODT, which can help reduce sensitivity to light and sound
• Zavzpret, a nasal spray, and
• anti-nausea drugs, such as metoclopramide (Gimoti, Reglan) or prochlorperazine (Compro, Compazine).

While migraines often "announce" they're coming—giving you time to prepare—cluster headaches come and go with little warning, meaning treating them can be a challenge. People with cluster headaches have several options for the treatment of their immediate symptoms. The two used most often (oxygen therapy and triptans) can effectively relieve immediate pain, but don't shut down the cluster.

Preventive therapies can be used at the onset of a cluster period to suppress, minimize, or eliminate additional headaches. Once the cluster ends, your doctor helps you taper off the medication.

• Calcium channel blockers such as Verelan are the most prescribed preventative medications. They have relatively mild side effects, but can take some time to be effective and don't work for everyone.
• Corticosteroids like prednisone can have serious side effects with long-term use, so they are sometimes prescribed for people who don't get cluster headaches often and whose clusters don't last very long.
• Galcanezumab (Emgality) is a monthly shot that's given until the cluster period ends.
• Lithium (Lithobid) is better known as a treatment for bipolar disorder, but is thought to help prevent chronic cluster headaches. It may be prescribed when other medications haven't been effective.

Other therapies can include noninvasive vagus nerve stimulation (VNS)—which sends electrical stimulation to the vagus nerve through the skin—or nerve blocks, which involve a shot of pain relieving medication into the back of the head near the occipital nerve.

Applying for Social Security Disability for Migraines

To receive Social Security disability benefits for migraines or any other headache disorder, you must first apply for them. The most convenient way to apply is by filling out the online application. You can complete the application anytime you like and you don't have to finish it in one session. Once you begin the online process, you'll receive an application number that you can use to stop and start your application as often as you need to without losing the information you've already entered.

You can also apply for disability benefits by calling 800-772-1213 Monday through Friday between 8 a.m. and 7:00 p.m. to speak to a representative—but expect long wait times. TTY is available for the hearing impaired at 800-325-0778. A better way to apply is to make an appointment with your local field office.

What Documents You'll Need to File for Disability

No matter how you file your application, there are certain documents you'll need. So, before you begin, gather as many of the following as you can:

• your birth certificate or other proof of birth
• proof of U.S. citizenship or lawful alien status (if born outside the U.S.)
• W-2 forms for last year
• self-employment tax returns for last year
• any medical evidence already in your possession, including medical records, doctors' reports, and recent test results, and
• proof of any temporary or permanent workers' compensation-type benefits you received (award letters, pay stubs, settlement agreements, and the like).

Don't delay starting your application because you're missing some of these documents. SSA representatives can help you gather anything you're missing.

What Happens After You Submit Your Application

Your local Social Security office will process your application no matter how you apply. Then, Social Security will send your file to your state's Disability Determination Services (DDS). A claims examiner at DDS will analyze your file, further investigate your case, and eventually determine whether or not your disability claim is approved.

The claims examiner will request copies of your medical records directly from your providers. But it can help speed up the decision process if you submit any records that you have to your local Social Security office or to the DDS office directly. The examiner might also call you for a phone interview, send you additional reports to complete, or ask you to go for a doctor's exam (at the agency's expense).

When Will I Hear About the Decision On My Claim?

You'll receive your disability decision by mail. In general, it takes three to four months to get an initial denial or award letter from Social Security. If your claim is approved, your award letter will explain your monthly benefit amount, the amount of any back pay owed to you, and when you can expect to receive your benefits.

If DDS denies your disability claim for migraines or cluster headaches, don't give up—you can file an appeal. For example, it can be hard to get disability benefits for cluster headaches because they're intermittent. But the fact that the claims examiner denied you at the initial application stage doesn't mean that you can't win disability benefits on appeal.

Getting Legal Help for Your Disability Claim

Migraines and cluster headaches are some of the hardest medical conditions to get disability benefits for. Many claims examiners, disability judges, and even doctors tend to underestimate the level of pain that occurs with a migraine or cluster headache if they haven't experienced it themselves. Convincing them that you have debilitating migraines can be an uphill battle.

That's why it's a smart idea to hire an experienced disability attorney to help with your claim, especially if you've already been denied and want to strengthen your appeal chances. Your lawyer can help you identify and fix any weakness in your case, gather any medical evidence needed to show that you equal a listing, and cross-examine any medical experts who may testify at your disability hearing. Most disability lawyers offer free consultations and are only paid if you win your claim, so there's little risk in hiring an attorney to work with you on your case.