As of August 26, 2019, the Social Security Administration (SSA) adopted SSR 19-4p, a new regulation that discusses the evidence needed to establish primary headache disorder as a medically determinable impairment. This regulation also distinguishes between primary headaches, which are covered by this provision, and secondary headaches, which are not.
As of August 26, 2019, the Social Security Administration (SSA) adopted SSR 19-4p, a new regulation that discusses the evidence needed to establish primary headache disorder as a medically determinable impairment. This regulation also distinguishes between primary headaches, which are covered by this provision, and secondary headaches, which are not.
The regulation defines headaches as “complex neurological disorders involving recurring pain in the head, neck, or scalp”. Primary headache disorders are defined as those which occur independently and are not caused by another medical condition. Examples noted include migraines, tension-type headaches, and cluster headaches. Conversely, secondary headaches would be those which occur as symptoms of another medical condition, such as headaches that are attributable to hypertension, fibromyalgia, or tumors.
SSR 19-4p establishes several avenues for establishing that an individual has a primary headache disorder. The regulation is clear that self-reporting by the individual is insufficient by itself. Instead, an individual may establish a primary headache disorder by a diagnosis from an acceptable medical source that reviewed the person’s medical history, conducted a physical exam, made the diagnosis only after exclusion of alternative medical and psychiatric causes of the person’s symptoms. Moreover, this provider’s treatment notes must be consistent with the diagnosis of a primary headache disorder.
Another means of establishing a primary headache disorder is by observation of a headache event. The regulation notes that that a detailed description of the event and associated phenomena by an acceptable medical source of symptoms like tremors, problems concentrating or remembering, dizziness, gait instability, and need to be in a dark room can be used to establish the diagnosis. The SSR also notes that the SSA may consider a third party observation. SSA will also look at remarkable or unremarkable laboratory findings (i.e. CT scans, MRIs, etc) and response to treatment. In other words, if an individual responds to treatments like medication or Botox that are typically used to treat primary headache conditions, this can serve as proof of such a disorder.
Social Security regulations and rulings concerning different impairments and the manner in which they are evaluated can pose evidentiary obstacles to establishing that you are suffering from a debilitating condition. This is another reason why it is in your best interest to work with an experienced disability law firm if you or someone you know is considering applying for disability benefits.
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