Migraine headaches can be debilitating, and, in some cases, chronic. In this post, we will look at some of the symptoms of migraines, how they are diagnosed, and some common treatments for migraines.
Migraines are characterized by severe headaches that usually involve throbbing pain felt on one side of the head, and can be accompanied by symptoms such as nausea, vomiting, and/or sensitivity to light and sound.
Migraines are the third most prevalent illness in the world, and can interfere with an individual’s ability to work and complete day-to-day activities, especially for those suffering from chronic migraines. Some studies have determined that healthcare and lost productivity costs associated with migraines may be as high as $36 billion annually. Migraines can affect anyone—in the U.S. 18% of migraine sufferers are women, 6% are men, and 10% are children. They are more common in individuals aged 25 to 55 and in those with family members that also suffer from migraines.
Migraine symptoms, frequency, and length vary from person to person. However, they usually have four stages:
Prodrome: This occurs one or two days before a migraine attack and can include mood changes, food cravings, neck stiffness, frequent yawning, increased thirst and urination, and constipation.
Aura: This stage can occur before or during a migraine attack. Auras are usually visual disturbances (flashes of light, wavy or zigzag vision, seeing spots or other shapes, or vision loss. There can also be sensory (pins and needles, numbness or weakness on one side of the body, hearing noises), motor (jerking), or speech (difficulty speaking) disturbances. While auras often occur 10 to 15 minutes before a headache, they can occur anywhere from a day to a few minutes before a migraine attack. Typically, an aura goes away after the migraine attack, but in some cases, it lasts for a week or more afterwards (this is called persistent aura without infarction).
Migraine: The migraine itself consists of some or all of the following symptoms:
- Pain on one or both sides of the head that often begins as a dull pain but becomes throbbing
- Sensitivity to light, sound, odors, or sensations
- Nausea and vomiting
- Blurred vision
- Dizziness and/or fainting
- Migrainous stroke or migrainous infraction (in rare cases)
Post-drome: This stage follows a migraine and can include confusion, mental dullness, dizziness, neck pain, and the need for more sleep.
A migraine can last anywhere from a few hours to several days, and there are several classifications of migraines, including:
- Classic migraine – migraine with aura
- Common migraine – migraine without aura
- Chronic migraine – a headache occurring at least 15 days per month, for at least three months,
eight of which have features of a migraine
- Status migraine – (status migrainosus) a severe migraine attack that lasts for longer than 3 days
The exact causes of migraines are not clearly understood but involve abnormal brain activity, including (1) changes in the brain stem and its interactions with the trigeminal nerve and (2) imbalances in brain chemicals, including serotonin. Migraines are most often triggered by:
- Food and food additives (often salty or aged food, MSG, meats with nitrites, aspartame)
- Skipping meals
- Drink (alcohol, caffeine, caffeine withdrawal)
- Sensory stimuli (bright or flashing lights, strong odors, loud noises)
- Hormonal changes or hormone medication such as birth control
- Certain other medications
- Stress or anxiety
- Strenuous exercise or other physical stress
- Change in sleep patterns
- Changes in weather
Migraines have been shown to co-occur with several other conditions, including:
- Cardiovascular disorders, coronary heart disease, and hypertension
- Psychiatric disorders (anxiety, depression, bipolar disorder)
- Restless leg syndrome
- Chronic pain such as musculoskeletal pain
There are a variety of options that doctors employ to both treat and prevent migraine attacks.
- Pain-relieving medications (both over the counter and prescription)
- Preventative medications (which can include antidepressants, blood pressure
medications, and seizure medications)
- Transcutaneous supraorbital nerve stimulation (t-SNS)
(a headband-like device with attached electrodes)
- Massage therapy
- Cognitive behavioral therapy (CBT)
- Herbs, vitamins, and minerals
- Relaxation exercises
- Sticking to a sleep schedule
- Avoidance of known triggers
Doctors also sometimes recommend keeping a headache diary, similar to a pain journal, which can help you track the frequency of your migraines and may help identify triggers.
These posts are for informative purposes only and should not be used as a substitute for consultation with and diagnosis by a medical professional. If you are experiencing any of the symptoms described below and have yet to consult with a doctor, do not use this resource to self-diagnose. Please contact your doctor immediately and schedule an appointment to be evaluated for your symptoms.
Mayo Clinic, www.mayoclinic.org
 Migraine Research Foundation, About Migraine, http://migraineresearchfoundation.org/about-migraine/migraine-facts/
 Wang, Shuu-Jiun, et. al., Comorbidities of Migraine, Frontiers in Neurology, Aug. 23, 2010, http://journal.frontiersin.org/article/10.3389/fneur.2010.00016/full
 Id. (citing Von Korff M., et. al., Chronic spinal pain and physical-mental comorbidity in the United States: results from the national comorbidity survey replication, Pain 113, 331-330 (2005).
If you are thinking about filing a disability claim, you are likely wondering whether you will be able to meet your monthly expenses if you’re no longer able to work. You may have made a list of your necessary expenses, and likely included your disability insurance premium payments on that list, as your agent likely told you that your policy would lapse and you would lose your coverage if you missed a premium payment. At this point, you probably started to wonder whether you still have to keep paying the premium after you file the claim, and if so, for how long?
The answer depends on the specific terms of your policy. The paragraph that you’ll want to look for when you’re reviewing your policy is typically titled “waiver of premium,” but some policies address waiver of premiums as part of a larger section of the policy that discusses premiums more generally.
How Do Waiver of Premium Provisions Work?
Generally speaking, waiver of premium provisions state that your insurance company cannot charge premiums during periods of time when you are disabled. A waiver of premium provision typically will also require your insurance company to reimburse you for premiums you have previously paid during your period of disability (i.e. the premiums that you paid while the insurance company was investigating your claim).
Waiver of premium provisions are included in most disability insurance policies. If you are considering purchasing a policy that does not include a waiver of premium provision, you may have the option to purchase a waiver of premium rider.
Here is an example of a waiver of premium provision from an actual disability insurance policy.
Under this policy, the waiver of premium provision requires you to pay premiums either for 90 consecutive days after you become disabled, or until the end of the elimination period (the elimination period is the number of days you must be disabled before you are entitled to benefits, and is usually noted on the first few pages of a policy).
So, for example, under this policy, once you have been disabled for 90 consecutive days, you no longer would have to pay premiums (at least until you recover from your disability, or your insurer terminates your benefits). You also would receive a refund of any premiums that you paid for any period prior to your date of disability.
Notably, the waiver of premium provision above also requires you to be receiving benefits for the waiver to apply. This is significant because, depending on the terms of your policy, in some cases you could be disabled but not receiving benefits. For instance, your policy might have a foreign residency limitation that prevents you from receiving benefits if you are living in another country, even if you remain disabled. In such a case, you might have to resume paying premiums until you returned to the United States in order to keep your coverage in force.
Timely and proper payment of premiums is critical, as a failure to pay premiums can result in you losing your disability coverage completely. It is important to read your policy carefully so that you have a clear understanding of when you are required to pay premiums, and when you are entitled to a refund of past premiums.
Most insurance companies will provide you with written confirmation that premiums have been waived, and it is best to keep paying your premiums until you receive this written confirmation, even if you think that you no longer have an obligation to pay premiums under the terms of your policy. If you have questions about whether your insurance company should have waived and/or refunded premiums under the terms of your policy, an experienced disability insurance attorney can review your policy and explain your rights and obligations under your particular policy.
In 2007, the Georgia Court of Appeals had to address this question in Pomerance v. Berkshire Life Insurance Company of America. 654 S.E.2d. 638 (2007). Alan Pomerance was an obstetrician/gynecologist with four disability insurance policies from Berkshire. These policies provided own-occupation coverage, meaning that “total disability” was defined as “your inability to perform the material and substantial duties of your occupation.”
Dr. Pomerance’s occupational duties included delivering babies, surgeries, C-sections, office visits, making hospital rounds, and being on call. After being diagnosed with a degenerative knee condition, Dr. Pomerance filed a total disability claim with Berkshire, explaining that he could no longer stand for long period of time, so he couldn’t perform deliveries and hospital surgeries, be on call, or assist in the emergency room. Because of his disability, Dr. Pomerance was forced to restrict his practice solely to wellness office visits, which included patient exams, counseling, nonsurgical care, and minor biopsies, but none of his other former duties.
Berkshire declined to pay Dr. Pomerance total disability benefits, arguing that he was only partially disabled because he could still perform one of his “substantial” duties, i.e., office visits. Dr. Pomerance contacted Berkshire and objected to its determination, but Berkshire still refused him total disability benefits. Dr. Pomerance filed suit against Berkshire, claiming breach of contract and bad faith refusal to pay the amounts owed. Continue reading “Case Study: What Does “Material and Substantial” Mean?”
Almost one in five people in the United States have a disability, according to the new U.S. Census Report Bureau that was just released today. The disability report was released to coincide with the 22nd Anniversary of the Americans with Disability Act, which is tomorrow. Here is some of the highlights from the disability report cited from the U.S. Census Bureau’s disability news release:
- 56.7 million people, 19 percent of the U.S. population, had a disability in 2010. And more than half of these disabilities were reported as severe.
- People in the oldest age group — 80 and older — were about eight times more likely to have a disability as those in the youngest group — younger than 15 (71 percent compared with 8 percent). The probability of having a severe disability is only one in 20 for those 15 to 24 while it is one in four for those 65 to 69
- About 8.1 million people had difficulty seeing, including 2.0 million who were blind or unable to see.
- About 7.6 million people experienced difficulty hearing, including 1.1 million whose difficulty was severe. About 5.6 million used a hearing aid.
- Roughly 30.6 million had difficulty walking or climbing stairs, or used a wheelchair, cane, crutches or walker.
- About 19.9 million people had difficulty lifting and grasping. This includes, for instance, trouble lifting an object like a bag of groceries, or grasping a glass or a pencil.
- Difficulty with at least one activity of daily living was cited by 9.4 million noninstitutionalized adults. These activities included getting around inside the home, bathing, dressing and eating. Of these people, 5 million needed the assistance of others to perform such an activity.
- About 15.5 million adults had difficulties with one or more instrumental activities of daily living. These activities included doing housework, using the phone and preparing meals. Of these, nearly 12 million required assistance.
- Approximately 2.4 million had Alzheimer’s disease, senility or dementia.
- Being frequently depressed or anxious such that it interfered with ordinary activities was reported by 7.0 million adults.
- Adults age 21 to 64 with disabilities had median monthly earnings of $1,961 compared with $2,724 for those with no disability.
- Overall, the uninsured rates for adults 15 to 64 were not statistically different by disability status: 21.0 percent for people with severe disabilities, 21.3 percent for those with nonsevere disabilities and 21.9 percent for those with no disability.
The 9th Circuit Court of Appeals in San Francisco, California told Disneyland it must consider permitting use of Segways by disabled people in its theme park. A Segway is a two-wheeled mobility device operated while standing.
The dispute arose when Disneyland denied the request of a disabled woman, who suffered from limb girdle muscular dystrophy, to use a Segway in the park rather than a motorized wheelchair. The disabled woman wanted to celebrate the birthday of eight-year-old daughter by taking her to the happiest place on earth. She wanted to use a Segway rather than a motorized wheelchair because the Segway would enable her to remain standing, which she prefers because her disability makes it very difficult for her to stand up from a seated position.
The Court of Appeals in California held that federal law required Disneyland to consider permission of Segway-use by people with disabilities: “As new devices become available, public accommodations must consider using or adapting them to help disabled guests have an experience more akin to that of non-disabled.” In order to disallow the Segway, Disneyland will have to demonstrate at trial how its usage would be unreasonably dangerous to patrons.
To read the news article from the Los Angeles Times, click here.
Get it in Writing – Why Verbal Communications with Your Disability Insurance Company Can Be Dangerous
We often advise doctors and dentists facing a disability insurance claim to handle all of their communications with the insurance company via mail rather than on the telephone. There are several reasons why written letters are better than verbal communication. For example:
• Claims handlers are trained to ask loaded questions. While the questions they ask may seem routine or mundane to the policyholder, the answers they elicit can have serious consequences that can help the insurance company deny a legitimate claim. For example, a claims administrator might call and ask what you have been doing that day. If you answer that you went out to pick up a prescription, the claims administrator can misconstrue your response as proof that you are not disabled from your occupation. No matter how short or how unavoidable your errand may have been, the insurance company can argue that if you are able to leave the house and perform limited activities, you can still perform your job. If the same question is posed in a letter, you can take the time to carefully consider the question and its consequences, preferably having a disability insurance lawyer help you to answer in a way that won’t be misconstrued.
• Telephone conversations may not be documented accurately. When a claims handler calls a policyholder to discuss his or her disability benefits, the handler will normally write a memo of what was said during the call for the claim file. These memos are used as evidence for disability benefit determinations, and potentially for later litigation. The primary problem is that the memos are written by the claims handler for the benefit of the insurance company, so whether intentionally or not, they are one-sided and biased towards the company’s interests. Another problem occurs when the claims handler doesn’t write a call memo at all; important conversations can be lost entirely. On the other hand, if a policyholder exchanges letters with the insurance company (and keeps copies), the insured can document his or her side of the story without worrying that something will be lost or misreported.
• Insurance companies use jargon that can be hard to understand. As Unum’s UK CEO has admitted, insurance companies use language that is indecipherable to most policyholders. If a claims handler calls you to talk about an elimination period, reservation of rights, ERISA, or the own-occupation definition of disability, you may not be able to completely process what he or she is telling you on the spot. This can cause you to miss important details or inadvertently waive important rights. If the same information comes to you in writing, however, you have time to research the terms and/or get advice from a disability insurance attorney.
For these reasons and more, it is crucial to get communications with your disability insurance company in writing. At the very least, a person filing for disability insurance benefits should take detailed notes of every conversation with an insurance company representative.