Do Not Forego Keeping A Migraine Journal (or Do So At Your Own Risk To Your Case)
Updated: Jul 11, 2022
Note: This article/video is for general information only and is not legal advice to any particular reader or individual. For legal advice, you must specifically retain a lawyer who evaluates your specific situation.
It is ALWAYS a good idea to keep a symptom journal, for more reasons than your Social Security Disability case alone. However, it is a superb choice for SSD cases. Click below for brief video explanation.
I recently came across this little comment used by an ALJ in a denial of a claimant with a claim of migraine/headaches:
ALJ: "It was noted the claimant had not kept a headache diary as instructed."
So here, not only did the claimant not journal her migraines over the months or years, which from our perspective can be great supportive proof later that they actually occur with the frequency claimed, but she was actually medically advised to by her migraine specialist (usually a neurologist); but she chose not to follow that medical advise. She did not comply with her neurologist's request that she journal (which helps track if medication is helpful, worsening of condition, etc.). It is a super simple thing to do.
For severe symptoms that effect your day to day when: your doctor cannot witness what you go through, test you, and you cannot objectively otherwise prove each day's limitation - keep a journal. A migraine journal (or seizure, or IBS, or vomiting syndrome, or leg edema/elevation) kept in real time, provides support at a later time at hearing, when a claimant testifies to 6-7 migraines per month, lasting X hours on average, that he is accurately recalling the severity and frequency accurately.
A journal notation should be done close in time to when the severe disabling symptoms are taking place, each and very time. It is fresh, real time, not a recollection. (Recollections can be fuzzy and so may not be as credible for reliability reasons, not to mention, some ALJs may skeptics of motivations.) Real time recording in a journal is not based on remote memory, emotionalism, or any other less than accurate mode of recollection. It was written down in the time frame in which it occurred, usually within a day of the migraine either mitigating to tolerable (in terms of now being able to write in the journal, or texting it into a phone calendar), or migraine ending altogether.
Details: Here are examples of potentially relevant notations and how one may include it in the calendar's days' box (although any other legend would work, so use what works for you without leaving out these relevant symptoms if they apply)
"M 6h V Naus NS LS BDR" M = Migraine
6h = 6 hours
V = with Vomiting
Naus = with Nausea
NS = with Noise Sensitivity
LS = with light sensitivity
B = Bedridden
BDR = Bedridden in Dark Room
Other occurring symptoms may include dizziness, vertigo, etc.
Triggers: You can also include any known Triggers, if the Migraine was triggered by an activity. For instance, let's say that 4 hours of being up and about, in regular lighting, without an intervening short break of lying down for a spell in the middle, triggers a migraine. Let's say you had no choice but to not do your regular genteel schedule to avoid the migraine; you had a doctor appointment 45 minutes away, which made the chore exceed 4 hours, due to travel, waiting room, etc.; it prompted the known risk of migraine.
Documenting that pre-activity that triggered the migraine can later support your claim that your medical condition requires significant lifestyle modification just to avoid the debilitating migraine.
Other triggers could include merely exposure to too much noise, lights, fumes. Other times, simply being up and about, however lightly, without laying down periodically can do it for some.
Importance of ongoing reporting to treating provider: Note that your journal should likely not be the ONLY place this information is found. You should consider reporting the triggers to your doctor, including if that necessitates reporting it via the medical portal messaging system monthly or so. (See here for guidance on keeping your legal affairs close to the vest - you doctor may not be the best person to share unnecessary information with of that nature.) Perhaps, it would be helpful to send a brief message to your migraine doctor every time you have a migraine that is not aborted by your medication within a few hours (although still note those shorter, successfully aborted migraines also, in your journal, even if not reported to doctor via messaging in real time.)
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