Migraine can be incredibly disabling. According to the Global Burden of Disease study, migraine is the second leading cause of disability overall and the leading cause of disability for adults under 50 years old, both in the US and worldwide. About 20% of people with chronic migraine consider themselves to be occupationally disabled.

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Most of the lost productivity at work related to migraine stems from presenteeism (coming to work not feeling well, just pushing through and not being as productive due to a migraine attack). About a quarter of productivity loss at work in the US is due to presenteeism. Migraine is the second leading cause of presenteeism in the US after allergies.

How to get your disability acknowledged

According to the Americans with Disabilities Act, people with disability should be granted reasonable accommodations in the workplace. It's important to look up the code of regulations in your state regarding the meal and rest breaks you are entitled to. For example, you can find the minimum mealtime on this website by state. It may also be helpful to look the rules and regulations on breaks and accommodations in your employer guidelines/handbook.

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The ADA 2008 amendment stated that episodic disorders that substantially limit someone’s ability to work when the disorder is active are a disability. For most, migraine is a chronic disorder with episodic attacks. According to the ADA amendment, migraine can be recognized as a disability.  

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In August 2019, the Social Security Administration recognized migraine as a potential disability. However, applying for Social Security Disability Insurance (SSDI) on the basis of migraine is very difficult. SSA only approves about 17% of the initial claims for headache, compared to 78% of claims for Parkinson's disease, for example. Migraine does not appear as a separate entity in the Social Security blue book.

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Obtaining disability is sometimes necessary, but it is a last resort, since it is difficult from a technical, emotional, and financial standpoint. The SSDI application requires objective data such as a normal brain MRI, a headache diary, migraine signs and symptoms reported by the clinician or a third party (not the patient). Those symptoms can include difficulty concentrating, difficulty remembering, face swelling or sweating, runny nose, droopy eyelids, persistent headache despite optimal management, or the need to be in a quiet, dark room. As an alternative, the FMLA act for short term disability can also be used intermittently for missed workdays due to migraine.

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For so many reasons, it can be very hard to go back into the workforce too after being on disability, so keep that in mind as you consider whether to apply.

Prepare for your visit with your headache provider

Most headache providers are not trained in pain law nor disability assessment, so it sometimes may be difficult for them to understand your work functions and how your migraine impacts your ability to perform the necessary tasks at your job. Although migraine is so common and disabling, everyone is different and is affected by migraine in a different way.

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Come to your visit prepared with a headache diary, a list of the medications you are taking (including the frequency at which you are taking acute medications), and a list of your essential work functions and how migraine interferes with those work functions. Please be prepared to explain what your work environment would be in a perfect world, to enable you to be as productive as possible. All this information will help you engage in an open discussion with your headache provider.

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The first step will be to discuss whether you have developed new symptoms or medication side effects, investigate if anything has changed, and assess whether a further workup is warranted. The second step is working towards medically optimizing your migraine as much as possible. Your headache provider may write a letter to your supervisor or help fill necessary paperwork. Your headache provider may also refer you to an occupational specialist and/or advocacy organizations who can help guide and support you.

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Neura Health's neurologists do treat many patients who are on disability and are familiar with the paperwork and criteria. If you believe you should qualify for SSDI and need to speak with a headache specialist about your condition and figure out next steps, Neura is available to help. If your Neura neurologist believes SSDI is medically necessary for you, we would gladly advocate on your behalf and fill out the paperwork that is needed. Start your Neura Health membership trial to set up a video appointment.

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