Our office quite commonly represents individuals suffering from headache issues that have become severe, persistent and disabling such that they remain unable to work. Pursuing such a Social Security disability claim can prove to be a very difficult proposition.
Every claim requires that an individual begin by showing that they are suffering from a medically determinable severe impairment. The Social Security regulations (and, specifically, 20 C.F.R. §404.1521) requires as follows: “[y]our impairment(s) must result from anatomical, physiological, or psychological abnormalities that can be shown by medically acceptable clinical and laboratory diagnostic techniques. Therefore, a physical or mental impairment must be established by objective medical evidence from an acceptable medical source.” This can be easier said than done when it comes to headaches.
There are a panoply of medical conditions that can result in headaches. However, the more difficult circumstance is where the diagnosis itself is simply that of simply experiencing chronic headaches.
As a Social Security lawyer handling disability claims out of Maine, Massachusetts and New Hampshire for the last 29 years, we frequently represent individuals in claims that involve, for example migraine headaches or what are referred to as cluster headaches. Proving objectively that such headaches do indeed exist, and remain severe and disabling, requires appropriate documentation from one’s treatment provider. First and foremost, we recommend that treatment take place with a specialist, which would be a neurologist, and that visits take place consistently so that the frequency, severity, location and duration can be properly documented. An initial diagnosis will require significant history taking and objective testing to rule out organic causes for one’s condition.
One type of severe headache, referred to as migraines do have certain tell tale signs and symptoms that ideally are detailed by one’s treating neurologist throughout their notes. Migraine episodes or attacks, sometimes referred to as “suicide headaches” as the level of pain can be so severe, can last for hours or even days. Many individuals experience warning signs known as an “aura” that can be in the form of blind spots, or other visual disturbances such as light flashes or seeing shapes or bright spots, tingling on one side of one’s face or down an extremity, difficulty speaking, hearing noises or music, among others. A migraine might also be accompanied by nausea and vomiting, and with a period following the seizure referred to as “post-drome,” that may include feeling exhausted/drained following the migraine.
Triggers can include certain types of foods, alcohol, highly caffeinated beverages and stress, and following one’s treatment providers’ recommendations with reference to avoiding certain triggers is very important (both personally and in terms of showing the Social Security Administration (SSA) that one remains disabled despite prescribed treatment). Likewise, attempts at medication management for migraines would be anticipated by SSA, with efforts at migraine prophylactics such as beta blockers, or SSRI (for example, Zoloft, Prozac and Paxil) and/or SNRI inhibitors (Cymbalta and Effexor) be expected, along with the prescriptions for Triptan medications (such as Imitrex and Zomig) once a migraine is occurring.
Another type of headache, called “cluster headaches,” has quite a different pattern than migraines. The cluster period typically lasts 6 to 12 weeks headaches followed by periods of remission (with no headaches occurring for months). These cluster periods many times occur the same time each year, and individuals may experience what are called episodic cluster headaches (with headaches occurring for a period of one week to a year, followed by a pain free period that can last up to 12 months) or what are called chronic cluster periods that can last for more than a year (with pain free periods lasting less than one month). During the cluster period, headaches are usually daily, sometimes several times a day, can last 15 minutes to 3 hours, can occur at the same time each day and with most attacks occurring at night. Signs and symptoms can include similar nausea and aura issues to migraines, with headaches involving excruciating pain around one eye, that may radiate, one-sided pain, redness and/or excessive tearing in one eye, forehead or facial sweating, facial flushing or pale skin, swelling around the affected eye or a drooping eyelid.
Once again, one of the triggers can be alcohol and so avoiding alcohol should be understood. Treatment can include 100% Oxygen inhaled through a mask for brief periods during the course of a headache and once again Triptans (in injection, as well as inhaler and pill form). Other treatment available includes or Octreotide (Sandostatin), which is injectable, Lidocaine (Xylocaine) as an inhalant, and Dihydroergotamine, which is available in injection and as an inhalant (Migranal).
Keeping a headache diary both for purposes of diagnosis and treatment and your Social Security disability claim can prove quite useful.
Certainly, in addition to the headache classifications listed above, headaches may also occur as a symptom of other objectively identifiable medical conditions that can be established through testing such as an MRI or CT scan, etc. Headaches may be very well understood and explainable based on the nature of the underlying condition. Examples of such conditions might include such objective conditions as a tumor or cyst in the brain, trigeminal neuralgia, a blood clot or other vascular disorder, or a cervical disk issue.
If in fact you or someone you care for has been experiencing headaches that persist to the point where their daily life, including their ability to work has been compromised, suggest they contact the Law Offices of Russell J. Goldsmith at 1-800-773-8622 for advice as to whether Social Security disability benefits may be an appropriate resource to pursue.