Sarah H. Bohr, Eleventh Circuit Representative, Past President

Following oral argument, the Eleventh Circuit recently reversed and remanded in Wright v. Comm’r of Soc. Sec., No. 24-11084, 2026 WL 1481204, 2026 U.S. App. LEXIS 15080 (11th Cir. May 27, 2026), a migraine headache case, holding that the ALJ “failed to properly consider [Appellant’s] migraine headaches at step three of the sequential disability evaluation process by not addressing whether they medically equaled epilepsy under Listing 11.02(B) and Social Security Ruling (‘SSR’) 19-4p.”

The case was remanded, despite the lack of a medical source opinion addressing migraine headaches or medical equivalency because the treating neurologist’s treatment notes documented the SSR 19-4p factors, including the frequency, duration, and severity of migraine headaches, with a detailed description of Appellant’s typical migraine events. The reasoning of the court is useful to practitioners who have clients with well-documented migraine headaches.

The Eleventh Circuit noted in Wright that:

a diagnosis that is not included in the Listing of Impairments, 20 C.F.R. pt. 404, subpt. P, app. 1, may still be found to be medically equivalent to a listed impairment “[i]f the findings related to” the claimant’s impairment “are at least of equal medical significance to those of a listed impairment.” 20 C.F.R. § 404.1526(b)(2).

Headache disorders, including migraine headaches, are not included in the Listing of Impairments. See generally 20 C.F.R. pt. 404, subpt. P, app. 1; see also SSR 19-4p. However, SSR 19-4p, which provides guidance on how the Commissioner evaluates primary headache disorders in disability claims, states that a person with a primary headache disorder may be able to establish that their headache disorder is medically equivalent to epilepsy as listed in Listing 11.02(B) or (D). SSR 19-4p.

Listing 11.02(B) was at issue in Wright.

As the court noted, “Listing 11.02(B) provides that epilepsy must be ‘documented by a detailed description of a typical seizure and characterized by . . . [d]yscognitive seizures . . . occurring at least once a week for at least 3 consecutive months . . . despite adherence to prescribed treatment.’” 20 C.F.R. pt. 404, subpt. P., app. 1, 11.02(B). The court observed that “[w]hile it is true that the ALJ did fail to cite Listing 11.02 or otherwise discuss SSR 19-4p, the question before us is whether the ALJ included enough information in her decision for this Court to infer that the ALJ considered whether Wright’s migraines met the relevant Listing” and held that it did not.

The court explained that “migraine impairment can be functionally equivalent to Listing 11.02(B) if severe headaches or migraines occur ‘at least once a week for three consecutive months. . . despite adherence to prescribed treatment.’” In evaluating whether a primary headache disorder is “equal in severity and duration to the criteria in 11.02B,” SSR 19-4p states that the ALJ will consider:

• A detailed description from an [acceptable medical source] of a typical headache event, including all associated phenomena (for example, premonitory symptoms, aura, duration, intensity, and accompanying symptoms);

• the frequency of headache events;

• adherence to prescribed treatment;

• side effects of treatment (for example, many medications used for treating a primary headache disorder can produce drowsiness, confusion, or inattention); and

• limitations in functioning that may be associated with the primary headache disorder or effects of its treatment, such as interference with activity during the day (for example, the need for a darkened and quiet room, having to lie down without moving, a sleep disturbance that affects daytime activities, or other related needs and limitations).

The Eleventh Circuit concluded that it lacks sufficient information:

to make this determination because the ALJ’s decision does not show that he considered whether Wright’s migraines meet or medically equal epilepsy under Listing 11.02(B) and SSR 19-4[p]. The ALJ’s decision merely concludes that none of Wright’s impairments, standing alone or in combination, met or medically equaled the severity of one of the listed impairments in the Listing of Impairments. The decision does not discuss Listing 11.02(B) nor does it mention SSR 19-4[p] at all. We contrast this with the fact that the ALJ specifically set forth and analyzed other listings pertaining to Wright’s other severe impairments.

The ALJ’s decision also contains no discussion of a medical source’s description of the migraines (including their duration, intensity, and accompanying symptoms) during the period for which Wright claimed disability, as required by SSR 19-4p. Additionally, while the decision mentions the frequency of Wright’s migraines during the period for which she claimed disability, it fails to address the side effects of the treatment, if any. True, the ALJ’s discussion of Wright’s RFC mentions her migraine headaches, but it does not touch upon all the criteria needed to deny equivalence to a listing.

We thus conclude that the ALJ’s opinion does not contain sufficient information to conclude that the ALJ properly analyzed Wright’s migraines in light of Listing 11.02 and SSR 19-4p.

The Eleventh Circuit did not reference SSR 17-2p in the Wright decision; however, the Commissioner’s argument that no discussion of medical equivalency was needed in light of SSR 17-2p was addressed at oral argument and implicitly rejected.

---

NOSSCR member Heather Freeman represented Ms. Wright in the Southern District of Florida and Heather and I both represented her before the Eleventh Circuit. I appeared for oral argument before Circuit Judges Rosenbaum, Lagoa and Marcus on April 29, 2026.

---

The views and opinions expressed in this article are the author’s own and do not necessarily reflect the views of NOSSCR, its leadership, or staff.

---