Migraines are very common and can be debilitating. But the pain and other symptoms associated with migraines are subjective, and there are no objective tests to directly measure their impact. Many long term disability insurance companies deny or terminate disability claims for migraines, citing a lack of objective evidence or insufficient proof that the condition is disabling to the individual. Fortunately, there are ways to “quantify” your suffering and prove that the condition is impairing your ability to work and live a normal life.
Affecting one in five women and one in 16 men, migraines vary widely in terms of symptoms, severity and frequency. A migraine headache can be characterized as throbbing or pulsing pain, usually on one side of the head. In some sufferers, the pain is preceded by a “prodrome” (pre-headache) phase and serves as a warning that a migraine event is imminent. As part of the prodrome phase, some migraine patients experience an “aura” of flashing lights, wavy lines, dots, blurry vision or blind spots. For other patients, the onset of migraine pain comes suddenly, without the prodrome warning.
The migraine pain, which typically lasts a few hours to three days, is often accompanied by sensitivity to light (photophobia) and/or sound (sonophobia), nausea, vomiting and visual effects. During a migraine attack, many sufferers will need to place themselves in a dark, quiet room while they wait for the symptoms to subside. Not unsurprisingly, fatigue, problems with sleeping, and cognitive impairments, especially with regard to attention and memory, are common complaints among migraine sufferers. Frequency of migraine events varies from rarely to several times a month.
Causes and treatments
Migraine causes are not fully understood, but for 70 percent of sufferers, there is a family history of the condition. Common triggers of migraine events include:
- hormonal changes in women
- excessive caffeine
- bright lights
- loud sounds
- strong smells
- intense physical activity
- poor sleep
- weather changes,
- or certain medications.
Lifestyle changes and preventive and relief medications, including over-the-counter and prescription painkillers, can improve symptoms, but side effects, including worsening nausea and vomiting and medication-overuse headaches, make the drugs intolerable for some patients.
Document your symptoms
Given the variation in migraine presentation, keeping a thorough migraine journal will go a long way in demonstrating how the condition impacts you. Journal entries should feature dates and times and include whether there is a prodrome, symptoms suffered during the prodrome and migraine event, their duration and intensity, and the level of impairment. Include any triggers that you noticed and the time required until you felt capable of resuming normal activities. It’s important to include any medications and other steps taken to try to alleviate your suffering, along with their impact, including any side effects.
Collect additional evidence
Visit a neurologist, who can typically diagnose a migraine based on the patient’s symptoms, medical and family history, and a physical and neurological exam. In some cases, an MRI or CT scan may be done to rule out other conditions. Bring your journal to your doctor appointments and discuss the frequency and intensity of your symptoms and how they impact your life, including your ability to work, and make sure your doctor keeps thorough notes. Try the treatments that the doctor recommends, including lifestyle changes and preventive and relief medications, and make sure your doctor documents how these interventions impacted your condition. Your medical record should demonstrate that you are collaborating with your doctor to manage your symptoms to the best of your ability.
In addition to your journal and doctor’s statement, functional capacity testing can provide further evidence that a migraine event impairs your ability to perform cognitive and physical functions. Statements from friends and family about your impairment during a migraine episode (“Jane needs to go into a dark room and sit quietly for two whole days at a time”) can provide additional objective evidence.
If your long term disability insurance claim has been denied or terminated or is being challenged, give us a call. We understand migraine pain, and we have the expertise and the tenacity to take on disability insurance companies who wrongfully challenge such claims. Contact us today for a free consultation.
Evan S. Schwartz
Founder of Schwartz, Conroy & Hack