Migraines and Seizure Disorders obviously have a one thing in common – the brain. But I am discussing these topics together for another reasons: they are hard to prove as a disability. The reasons for this are many. It is not very often that a person with a seizure disorder actually shows evidence of seizure or epileptiform brain activity on an EEG. Such documentation may require a more extended EEG monitoring period (of up to three days) and even then it may be normal. Similarly, it is rare that an MRI or CT scan shows something in the brain that could be the cause of migraines or chronic headaches. Additionally, seeking treatment for frequent migraines or seizures can bring its own problems. I see less of this now, but it is not uncommon for someone who goes to the emergency room for a severe migraine or recent seizure to be labelled a possible “medication seeker” by a wary, but perhaps well-intentioned, ER doctor.
Most people with these disorders just suffer through the headaches and seizures. Some don’t even know they have had a seizure unless, until they wake up in the morning on the floor with a bruised face or perhaps with soiled sheets. Those who suffer from petit mal or staring seizures likewise are not aware of having an episode unless someone is with them at that time who notices their absence.
Those with migraines, of course, are acutely aware that they are suffering, but the only response is to retreat to a dark, quiet room with a cold, damp towel, and try to sleep through it. These are usually private maladies.
The medications used to treat these impairments can sometimes have difficult side effects. Seizure medications can cause headaches and lethargy. Migraine medications often induce sleepiness that can last for hours. After a seizure or severe migraine, it may take a day or more for the sufferer to recover to their usual capability.
Social Security regulations state that you are disabled by seizures if you have at least one tonic-clonic seizure each month for at least three consecutive months or dyscognitive seizures occurring at least once every 2 weeks for at least 3 consecutive months, despite medication adherence (there are other considerations involved, but this is the gist of it – see Listing 11.02). Migraines or other headaches are evaluated under the categories of primary headache disorders, migraines, tension-type headaches, and trigeminal autonomic cephalgias and are evaluated under the criteria in the International Classification of Headache Disorders, third edition (see SSR 19-4p).
Whether headache or seizure, when evaluating the disability claim, Social Security is looking for consistent treatment which provides a description of the diagnostic criteria; testing documentation, as applicable; evidence that the patient is following prescribed treatment, including taking medication as ordered; and medical evidence documenting the frequency and severity of these symptoms.
It is not always easy to provide this evidence. Sometimes headaches are so common that a person can’t be expected to reach out to their doctor each time a headache occurs. This is the same with seizures.
There are a few ways to tackle this: First, follow through on referrals to specialists. Getting a referral to a specialist for a seizure disorder shouldn’t be hard. This is an urgent condition for which primary doctors always make a referral to a neurologist. Migraine sufferers sometimes are less likely to see a specialist, but you should ask the doctor to consider a referral. Second, discuss in advance with your doctor how she wants you to document your headaches or seizures. Does she want you to keep a log and send her periodic updates through email? Does she accept information gathered through an app like Migraine Buddy? Make sure that the doctor includes such information in her treatment notes so that this documentation is received and evaluated by Social Security as part of the disability claim. Third, keep a log of the events. Whether your doctor wants this information or not, you should track what is happening to you by date, duration, severity, and symptoms. Ask for help from family or roommates to track what is happening. If you are suffering from seizures, you may not know or remember to write the information down. I had one client whose son tracked the client’s seizures on a calendar he kept in the kitchen so that they could both use it. This evidence can be presented to the judge in your case and the person helping you can add their testimony by written declaration.