Social Security disability evaluation of cases involving primary headache disorders

The Social Security Administration (SSA) has issued a new Ruling about evaluating disability cases involving primary headache disorder.

Primary headache disorders are a collection of chronic headache illnesses characterized by repeated exacerbations of overactivity or dysfunction of pain-sensitive structures in the head. Examples include migranes, tension headaches and trigeminal autonomic cephalalgias.  They are typically severe enough to require prescribed medication and sometime warrant emergency department visits.  Physicians diagnose primary headache disorder only after excluding alternative medical and psychiatric causes of the symptoms, and after review of the full medical and headache history and conducting a physical and neurological examination.  The International Diagnosis of Headache Disorders -3 criteria are used to as diagnostic criteria and are included in the Ruling.

A diagnosis or statement of symptoms is insufficient to establish primary headache disorder as a medically determinable impairment.  To establish primary headache disorder as a medically determinable impairment, there must be consideration of the following findings by an acceptable medical source:

— A primary headache disorder diagnosis which must document review of medical history, a physical examination, and excluding alternative medical or psychiatric causes.

— An observation of a typical headache event by the acceptable medical source.  In the absence of such direct observation, Social Security can consider a third party observation of a typical headache event.

— Remarkable or unremarkable findings on laboratory tests. Social Security will not purchase tests related to headaches or allegations of headaches.

— Response to treatment.  Evidence documenting ongoing headaches that persist despite treatment may constitute medical signs to help establish a medically determinable impairment.

Although primary headache disorder is not a listed impairment, it can, alone or in combination with other impairments, medically equal a listing.  Epilepsy (listing 11.02) if the most closely analogous listed impairment to primary headache disorder.

If primary headache disorder does not medically equal a listed impairment, Social Security assesses residual functional capacity.   For example, symptoms such as photophobia may cause difficulty sustaining attention and concentration.  (SSR 19-04p, August 26, 2019.)

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