Migraines are a neurological disease that can make it impossible to perform the essential duties of a demanding occupation. Yet migraine-related long-term disability insurance claims can be among the more difficult disability claims to prove.
The problem is not necessarily that the migraine is undiagnosed. The problem is that migraine is largely diagnosed through clinical symptoms rather than a blood test, imaging study, or other laboratory test that objectively measures the severity of an attack.
This distinction is critically important when an insurance company evaluates a long-term disability claim.
A claimant may be experiencing severe pain, visual disturbances, nausea, cognitive impairment, light sensitivity, and exhaustion. An MRI may be normal. Blood work may be normal. A neurological examination between attacks may be normal.
But for the person experiencing the migraine, the disability is real. For an insurance company looking for evidence to support restrictions and limitations, however, the medical record may appear less definitive.
That is why migraine disability claims require careful documentation and, in many circumstances, the assistance of an attorney experienced in long-term disability insurance claims.
Migraine Is a Neurological Disease, Not Simply a Bad Headache
The medical evidence does not support treating migraine as an ordinary headache. According to the Mayo Clinic, migraine is a neurological disease that can produce intense throbbing or pulsing pain, frequently accompanied by nausea, vomiting and extreme sensitivity to light and sound. Attacks can last from hours to days and can interfere substantially with ordinary activities.
Some people also experience an aura before or during a migraine. Aura may cause flashes of light, blind spots, temporary vision changes, tingling, numbness or difficulty speaking.
For someone whose occupation requires sustained concentration, precise judgment, visual processing or constant interaction with other people, those symptoms can be profoundly disabling.
There is often another phase, equally disabling. after the headache itself. A person may remain exhausted, confused or cognitively impaired for hours after the principal pain subsides. This is known as the postdrome phase, which can last for up to a day.
Both pre, during and post migraine phases are important to a disability claim. The question to be asked is not simply how bad is your pain level, but “What can you reliably and safely do when these symptoms occur, how frequently do they occur, how long do they last, and how do they affect your ability to perform your occupation?”
Why a Normal MRI Does Not Mean the Migraine Is Not Real
One of the most frustrating aspects of a migraine claim is the normal diagnostic test. A claimant may undergo an MRI, CT scan or other neurological testing and learn their tests are all within normal ranges. This is common. Migraines are believed to be the result of abnormal brain function in the setting of a normal brain structure. An MRI primarily evaluates structure, not the functional abnormalities associated with migraine.
There is an extremely important distinction.
MRI and CT imaging may be used to investigate other potential causes of severe headaches, including tumors, bleeding, stroke, infection or other neurological conditions. But imaging generally does not “prove” an ordinary migraine. The normal MRI may be evidence that the physician has ruled out something more serious—not evidence that the patient is capable of working.
This is one reason migraine claims can become difficult in the insurance setting. The diagnosis is clinical, based upon the patient’s history, symptoms and examination. There isn’t a single laboratory test or imaging study that proves the person is suffering from migraines.
Why Insurance Companies Focus on “Objective Medical Evidence”
A denial letter in a migraine disability claim may contain familiar language: “There is insufficient objective medical evidence to support disability.”
An insurer may acknowledge that the claimant has been diagnosed with migraine. The denial focuses on whether the medical evidence establishes restrictions and limitations that prevent the claimant from performing the duties of the occupation.
A diagnosis alone may not explain why a person cannot work eight hours a day, five days a week. The medical record needs to connect the diagnosis to functional limitations. Most doctors won’t know this.
For example, “patient has debilitating migraines” is relatively useless for an LTD claim. Instead, the record must include a physician’s explanation that migraine attacks occur a certain number of times each month, last a specified duration, produce visual symptoms and nausea or other symptoms, require the patient to lie down in a dark environment, impair concentration and prevent sustained work. These articulated functional impacts are what supports a claim for disability insurance benefits.
Can Cognitive Testing Solve this Riddle?
Clients suffering migraine headaches often suffer cognitive impairment. Having cognitive testing that will tease out specific functional issues and deficits can help tremendously to support a disability insurance claim and should be considered where appropriate.
Functional Limitations Are the Center of the Claim
Consider an anesthesiologist who suffers from migraines. An anesthesiologist cannot simply “push through” a migraine if the condition causes visual disturbances, impaired concentration, slowed processing, or difficulty maintaining attention. This occupation demands precise medication calculations, accurate dosing, constant monitoring of vital signs and immediate responses to changing clinical circumstances.
There is no meaningful margin for cognitive impairment.
The same principle applies in less obviously safety-sensitive occupations. An attorney may need sustained concentration and rapid analysis. A financial professional needs to interpret complex information accurately. A software engineer needs prolonged screen exposure and problem-solving abilities. A teacher needs to remain attentive to a classroom for hours. An executive needs to participate in meetings, make decisions and communicate effectively throughout the day.
The disability analysis must therefore move beyond the word “migraine.” It must explain what happens to the person’s ability to perform the specific occupational functions when migraine symptoms occur.
The Importance of a Specialist’s Medical Documentation
The quality and consistency of medical treatment can become particularly important. A primary care physician may document that a patient continues to report headaches, but a long term disability claim requires considerably more detail.
For a claimant with persistent or disabling migraine, treatment by a neurologist or physician specializing in headache disorders may provide important clinical documentation concerning:
- Frequency of attacks.
- Duration of attacks.
- Severity and associated symptoms.
- Aura or visual disturbances.
- Nausea and vomiting.
- Sensitivity to light and sound.
- Cognitive symptoms.
- Medication response.
- Medication side effects.
- Required periods of rest.
- Expected absenteeism.
- Ability to maintain concentration.
- Ability to tolerate screens or other environmental triggers.
- Whether the condition is chronic or episodic.
Regular treatment is vital to establish a longitudinal medical record because disability insurers frequently evaluate whether the medical evidence demonstrates a consistent condition over time rather than an isolated period of symptoms.
Why Keeping a Detailed Headache Diary is Important
A headache diary can become an important part of the evidentiary record, with details. The diary should not merely say, “migraine—bad.” A useful record documents the date and time of onset, duration, severity, symptoms, suspected triggers, medication taken, response to medication and functional consequences.
It may also document whether the claimant:
- Had to leave work.
- Could not drive.
- Could not use a computer.
- Had to lie down in a dark room.
- Missed a meeting.
- Left work early.
- Required urgent medical care.
- Experienced medication side effects.
- Was unable to concentrate.
- Needed assistance with ordinary activities.
The objective is to accurately document what is actually happening.
Medication Side Effects Can Be Part of the Disability
Another common problem is the assumption that medication solves the problem. A medication may reduce migraine pain while creating another functional limitation. For example, medication may cause drowsiness, dizziness, nausea, or cognitive slowing. If those side effects interfere with safe and reliable work performance, they should be discussed with the treating physician and documented in the medical record.
A disability insurer should not be permitted to analyze treatment as though “medication prescribed” automatically means “capable of working.”
The relevant question is whether the overall treatment regimen allows the claimant to perform the essential duties of the occupation reliably and safely.
The Problem With “Pushing Through” a Migraine
Many high-achieving professionals have spent years working through migraines. They may retreat to a vacant office, turn off the lights, take medication, and wait for the symptoms to improve. From the outside, the employer may see an employee who showed up for work.
The employment record, however, may fail to capture the hours of productivity lost while the employee was sitting in a dark room unable to function. That history can become problematic when the person later files a disability claim.
The insurer may ask: “If you were able to work with migraines for years, what changed?”
The answer needs to be supported by the medical record. There needs to be documentation showing the progression from intermittent or manageable symptoms to symptoms that have become sufficiently frequent, severe, or unpredictable to prevent sustained employment.
Chronic Migraine and the Frequency of Attacks
Frequency can be especially important. The American Migraine Foundation describes chronic migraine as headache occurring on 15 or more days per month for more than three months, with at least eight of those days involving migraine features.
A person experiencing several disabling attacks each month may have a very different functional profile from someone experiencing an occasional migraine. The frequency, duration and recovery period should therefore be documented. So should the unpredictability.
Migraines can improve for periods and later become substantially worse. That variability can create another argument for an insurer: if the claimant has experienced periods of improvement, perhaps the claimant can return to work. But an occupation requires regular and predictable attendance.
Someone who cannot reliably predict whether they will be capable of concentrating, using a computer, driving, attending meetings or performing safety-sensitive tasks faces a significant occupational problem even if there are intermittent symptom-free periods.
Read the Disability Policy Before Assuming What Is Covered
Every long-term disability insurance policy needs to be examined on its own terms. Some LTD policies contain provisions that can affect claims based substantially on subjective symptoms. Some policies also contain special limitations concerning mental health conditions or other categories of disabilities.
The policies are legal contracts, so every word, every paragraph, every provision determines what will and won’t be covered in a claim.
The distinction between an employer-sponsored group policy and an individually purchased disability policy is also significant. ERISA may apply to employer-sponsored plans, while individually purchased policies are governed by different legal rules.
For an ERISA-covered disability plan, federal regulations establish specific claims procedures. The U.S. Department of Labor explains that disability insurance claims generally have specific decision-making and appeal procedures, and claimants are entitled to a full and fair review following a denial or termination of the disability claim.
That procedural framework is one reason a claimant should not assume that a disability claim is simply a matter of completing forms and submitting medical records. The policy, the governing law and the administrative claims process all matter.
Why a Vocational Evaluation Is Important
The insurer reviewing a disability insurance claim may challenge the connection between the migraine diagnosis and the ability to work. A strong claim for disability benefits therefore may require more than medical evidence. Vocational evidence can help explain the actual demands of the occupation and whether the claimant’s documented restrictions are compatible with those demands.
The issue is not whether the claimant can perform an isolated task on a good day. The issue is whether the claimant can perform the essential duties of their occupation consistently, safely, and reliably over the course of a normal work schedule.
