SSR 19-4p issued regarding evaluating cases involving primary headache disorders
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Monday, September 9, 2019

SSR 19-4p issued regarding evaluating cases involving primary headache disorders

The SSA has issued notice of SSR 19-4p, which provides guidance

on how the agency establishes that a person has a medically determinable

 impairment (MDI) of a primary headache disorder and how it evaluates

primary headache disorders in disability claims under Titles II and

XVI of the Social Security Act. The notice became effective on August

26, 2019.

In this SSR, the SSA explains how it establishes a primary headache

 disorder as a medically determinable impairment and how it evaluates

claims involving primary headache disorders. Question 1, below, explains

what primary headache disorders are. Question 2 explains how the medical

community diagnoses primary headache disorders. Questions 3, 4, 5,

and 6 provide the ICHD-3 diagnostic criteria for four common types

of primary headache disorders. Question 7 explains how the SSA establishes

a primary headache disorder as an MDI. Questions 8 and 9 address how

the agency evaluates primary headache disorders in the sequential

evaluation process. (Although this SSR only provides information about

four common types of primary headache disorders, diagnostic criteria

for other types of primary headache disorders can be found in the

ICHD- 3.)

What are primary headache disorders?

How does the medical community diagnose a primary headache

 disorder?

What are the ICHD-3 diagnostic criteria for migraine with

aura?

What are the ICHD-3 diagnostic criteria for migraine without

aura?

What are the ICHD-3 diagnostic criteria for chronic tension-type

headache?

What are the ICHD-3 diagnostic criteria for cluster headache

(a type of trigeminal autonomic cephalalgias)?

How does the SSA establish a primary headache disorder

as an MDI?

How does the SSA evaluate an MDI of a primary headache

disorder under the Listing of Impairments?

The SSA also considers the extent to which the person's impairment-related

 symptoms are consistent with the evidence in the record. For example,

 symptoms of a primary headache disorder, such as photophobia, may

cause a person to have difficulty sustaining attention and concentration.

Consistency and supportability between reported symptoms and objective

medical evidence is key in assessing the RFC.

For further information, contact Cheryl A. Williams, Office of

Medical Policy, Social Security Administration, 6401 Security Boulevard,

Baltimore, Maryland 21235-6401, (410) 965- 1020. See 84 Fed.

Reg. 44667, August 26, 2019.

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