Should a patient with severe migraines, as indicated by a high Migraine Disability Assessment Test (MDAT) score, be approved for short-term disability?

Medical Statement for Short-Term Disability Request: Severe Migraine with High MDAT Score

A patient with severe migraines documented by a high Migraine Disability Assessment Test (MIDAS) score meets objective criteria for short-term disability approval, as severe MIDAS scores (Grade IV, ≥21 points) correlate with marked functional impairment across work, household, and social domains that substantially limits the ability to perform essential job functions. 1, 2

Objective Disability Documentation

MIDAS scoring provides validated, quantifiable evidence of migraine-related disability that directly measures lost productivity:

• Grade IV MIDAS scores (≥21 points) indicate severe disability, with patients averaging 34.9 total disability days over 3 months in chronic migraine populations versus 19.3 days in episodic migraine 1
• Patients with chronic migraine miss an average of 5.3 days of work or school per 3-month period, compared to 2.3 days for episodic migraine (p=0.0007) 1
• Reduced effectiveness at work or school averages 11.9 days per 3-month period in chronic migraine versus 4.6 days in episodic migraine (p=0.0001) 1
• 64.3% of chronic migraine patients fall into MIDAS Grade IV, reflecting severe disability that prevents normal functioning 1

Clinical Significance of Severe MIDAS Scores

High MIDAS scores demonstrate substantial impairment across multiple life domains:

• Patients with chronic migraine experience 66.7 total headache days over 3 months versus 15.5 days in episodic migraine (p<0.001), indicating near-constant symptom burden 1
• Household work is impaired for 16.5 days per 3-month period in chronic migraine versus 3.3 days in episodic migraine (p<0.0001) 1
• Family, social, and leisure activities are missed for 7.0 days per 3-month period versus 5.5 days in episodic migraine (p=0.03) 1
• Health-related quality of life is significantly lower across most SF-36 domains compared to normative data, with marked reductions in Role Physical, Bodily Pain, General Health, Vitality, and Social Functioning 3, 4

Medical Necessity for Work Absence

The disability profile documented by severe MIDAS scores reflects inability to maintain employment standards:

• 58.6% of patients with chronic migraine are classified as Grade IV disability, indicating severe limitations requiring medical intervention 5
• The mean headache intensity in these patients averages 8.50 on a 0-10 scale, with an average of 32.25 headache days per 3-month period 5
• Only 20% of patients meeting chronic migraine criteria are properly diagnosed, suggesting many continue working despite severe impairment until formal assessment 6
• Patients demonstrate inability to work, attend social functions, and perform routine chores during symptomatic periods 6

Treatment Optimization Period Justifies Temporary Disability

Short-term disability is medically appropriate during the treatment optimization phase:

• Preventive therapy efficacy requires 2-3 months for oral medications to demonstrate effectiveness, during which time acute symptoms may persist 6
• CGRP monoclonal antibodies require 3-6 months for efficacy assessment 6
• OnabotulinumtoxinA requires 6-9 months for full efficacy evaluation 6
• Patients with chronic migraine who continue working despite severe disability experience lower health-related quality of life and greater economic burden than those with episodic migraine 6

Critical Clinical Context

Several factors strengthen the disability claim:

• Medication overuse headache (MOH) affects 69.8% of chronic migraine patients in specialty settings, requiring complete medication withdrawal that temporarily worsens symptoms before improvement 1
• The chronicity and pervasiveness of migraine is associated with increased functional impairment beyond simple headache frequency 1
• Physicians consider specific treatment necessary when disability information is documented, but often fail to adequately assess or treat when this information is not formally captured 2
• MIDAS scores are sensitive to clinical changes, making them appropriate for monitoring treatment response and determining when return to work is feasible 3

Recommended Statement Components

The disability documentation should include:

• Specific MIDAS total score and grade (Grade IV if ≥21 points) 1
• Number of headache days per month (≥15 days defines chronic migraine) 6
• Days of work missed and reduced productivity days from MIDAS questionnaire 1
• Current treatment regimen and timeline for expected improvement (2-3 months minimum for oral preventives) 6
• Presence of medication overuse requiring withdrawal period if applicable 1
• Comorbidities affecting disability (hypertension, psychiatric conditions) 5

This objective, validated disability assessment provides the medical justification for temporary work absence while aggressive treatment optimization is pursued, with the goal of restoring functional capacity and enabling return to full employment.