New Ruling Regarding Headache Disorders

Social Security issued a new ruling on August 26, 2019 regarding how headache disorders will be considered in disability claims.  SSR 19-4p details how Social Security will establish a Primary Headache Disorder as a Medically Determinable Impairment (MDI) as well as how Primary Headache Disorders will be evaluated under the Listings of Impairments and how to consider the Residual Functional Capacity (RFC).  A Primary Headache Disorder cannot be established simply by a diagnosis or statement of symptoms.  Social Security will now require the following combination of findings from an Acceptable Medical Source (AMS) in order to find a Primary Headache Disorder to be an MDI:

  • An AMS must diagnose a primary headache disorder.  The diagnosis must specifically identify the specific condition that is causing the symptoms.  There must also be evidence that the AMS reviewed the medical history, examined the person, and excluded other potential causes for the symptoms.
  • An observation of a typical headache event, and a detailed description of the event including all associated phenomena, by an AMS.  In the absence of direct observation of a typical headache event by an AMS, we may consider a third party observation of a typical headache event, and any co-occurring observable signs, when the third party’s description of the event is documented by an AMS and consistent with the evidence in the case file.
  • Remarkable or unremarkable findings on laboratory tests.
  • Response to treatment.  Examples of medications used to treat primary headache disorders include, but are not limited to, botulinum neurotoxin (Botox®), anticonvulsants, and antidepressants. Consideration will be given to whether the person’s headache symptoms have improved, worsened, or remained stable despite treatment and consider medical opinions related to the person’s physical strength and functional abilities.

SSR 19-4p indicates that, as there is no specific listing for Primary Headache Disorders, the condition should be considered under Listing 11.02 (Epilepsy).  As such, a person cannot meet Listing 11.02, but, they can medically equal Listing 11.02 if their condition is of similar severity, frequency and duration as that detailed in Listing 11.02.

When considering the RFC for a person with a Primary Headache Disorder, SSA will consider the limiting effects of the impairment and their related symptoms.  They use as an example the symptom of photophobia and how the symptom might impact a person’s ability to maintain attention and concentration to perform work-related tasks.

This ruling provides additional information and direction to SSA decision makers on how to consider Primary Headache Disorders.  See the link below for the full text of the document.

https://www.ssa.gov/OP_Home/rulings/di/01/SSR2019-04-di-01.html