Migraines are severe, recurring, and painful headaches. The article gives an overview of the condition along with symptoms, causes and treatment options.

1. Migraines – Types, Diagnosis,
Treatment and Prevention
Migraines are severe, recurring,
and painful headaches. The
article gives an overview of the
condition along with symptoms,
causes and treatment options.
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Regarded as a commonly prevalent neurological disease, migraine is a
complex condition with the tendency for the patient to experience headaches
with sensory disturbance. Characterized by intense, debilitating headache,
the condition causes instability in the way the brain deals with incoming
sensory information. Migraine can cause severe throbbing pain or a pulsing
sensation, usually on one side of the head, which is often accompanied by
nausea, vomiting, and extreme sensitivity to light and sound. Migraine
attacks can last for hours to days, and the pain can be so severe that it
interferes with one’s daily activities. People who experience severe migraine
attacks can take preventive medicines to eliminate or reduce pain
symptoms. However, the correct combination of medicines along with self-
help remedies and lifestyle changes may help prevent the occurrence of
pain. With the advancement of treatment techniques, billing and coding for
migraines can be challenging. Migraine specialists, neurologists or other
physicians treating this condition can rely on a professional medical billing
and coding company that understands this area of specialty and is familiar
with the latest diagnosis and procedure codes.
Migraines can begin in childhood or may not occur until early adulthood and
tend to affect people aged 15 to 55 years. According to the Migraine
Research Foundation, migraine affects 39 million
men, women and children in the United States and 1 billion worldwide. It is
estimated that women are three times more likely to suffer from migraine in
adulthood than men. In fact, 85% of chronic migraine sufferers are women.
Though migraine causes are not fully understood, genetics and
environmental factors appear to play a major role. Changes in the brainstem
and its interactions with the trigeminal nerve - a major pain pathway – may
also be involved.
Types of Migraines
Generally, migraines are classified into two main types. This classification
depends on whether the individual experiences any disturbances of the
senses leading up to a migraine. These are known as auras.
 Migraine with aura – This type occurs in 25 percent of people who
experience migraines. For many people, the aura acts as a warning
sign, telling them that a headache is soon to come. People
experiencing an aura may experience visual disturbances. Other
effects of an aura include – confusing thoughts or experiences, the

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perception of strange, sparkling or flashing lights, blind spots or blank
patches in the vision, pins and needles in an arm or leg, difficulty
speaking and stiffness in the shoulders, neck, or limbs.
 Migraine without aura - It is estimated that between 70 and 90
percent of migraines occur without an aura. According to the
International Headache Society, people who have migraine without
aura have had at least five attacks that have typical characteristics like
– headache attack (usually lasting 4 to 72 hours), pain that occurs on
only one side of the head, pulsating or throbbing pain, and headache
that makes people sensitive to light (photophobia) and sound
(phonophobia).
There are other types of migraine related to specific syndromes or triggers,
including – chronic migraine, menstrual migraine, hemiplegic migraine,
abdominal migraine and migraine with brainstem aura.
Symptoms
One of the main symptoms associated with this neurological condition is a
painful headache. The symptoms will vary from one person to another and
individuals may experience different symptoms during different attacks. The
attacks may vary in frequency and length and may generally last from 4 to
72 hours.
Migraines, which often begin in childhood, adolescence or early adulthood,
can progress through four stages – Pro-drome, Aura, Attack and Post-
drome. Not everyone goes through all stages. Symptoms experienced by
people at each of these four stages are listed below –
Pro-drome Stage – During this stage, people may experience subtle
changes or symptoms just one or two days before a migraine. These
symptoms include -
 Constipation
 Neck stiffness
 Mood changes, from depression to euphoria
 Increased thirst and urination
 Frequent yawning
 Food cravings

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Aura - Auras are reversible symptoms of the nervous system. During an
aura, people may experience problems with vision, sensation, movement,
and speech. Examples of migraine aura include –
 Weakness or numbness in the face or one side of the body
 Visual phenomena, such as seeing various shapes, bright spots or
flashes of light
 Vision loss
 Uncontrollable jerking or other movements
 Pins and needles sensations in an arm or leg
 Hearing noises or music
 Difficulty speaking
For some people, aura might occur before or during migraines. Each
symptom usually begins gradually, builds up over several minutes and lasts
for 20 to 60 minutes.
Attack – Regarded as the most acute or severe phase of symptoms, the
attack phase is when the actual migraine pain occurs. However, in some
people, this can overlap or occur during an aura. Attack phase symptoms
can last anywhere from hours to days and symptoms include –
 Increased sensitivity to light and sound
 Pulsing and throbbing head pain
 Pain on one side of your head, either on the left side, right side, front,
or back, or in your temples
 Nausea and vomiting
 Dizziness or feeling faint
Post-drome – People normally experience mood swings and changes in
feelings during the last phase. Mood swings and feelings can range from
feeling euphoric and extremely happy, to feeling very fatigued and
apathetic. In addition, a mild, dull headache may persist.
The exact cause of migraines is not yet clearly known. However, the most
common suspected cause is an abnormal activity in the brain, which can
affect the way nerves communicate as well as the chemicals and blood
vessels in the brain. Other factors that are likely to set migraine triggers
include – hormonal changes, emotional factors (like stress, depression,
anxiety, excitement, and shock), physical causes (tiredness and insufficient

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sleep, shoulder or neck tension, poor posture) and alcohol and caffeine
intake.
Migraine Tests and Treatment
Physicians diagnose migraines by performing a thorough medical and family
history review to analyze the different symptoms. In some cases, a physical
and neurological examination may be performed to identify other potential
causes of the symptoms. Imaging scans, such as a CT scan or MRI, can rule
out other causes including – tumors, abnormal brain structures and stroke.
Migraine headaches cannot be fully cured, but neurologists can help patients
better manage their symptoms and make their incidence less often.
Treatment choices for this condition depend on several factors like – age,
frequency of occurrence, type of migraine, severity of pain and other related
symptoms like nausea or vomiting. Treatment for this condition involves a
combination of self-help remedies, lifestyle adjustments (including stress
management and avoiding migraine triggers), pain relieving and preventive
medications and hormone therapy (if migraines tend to occur in relation to
your menstrual cycle).
Medications include both those for prevention and those for treatment during
a migraine attack. These include over-the-counter or prescription pain
relievers like - aspirin or ibuprofen (Advil, Motrin IB, others), Triptans,
Dihydroergotamines (D.H.E. 45, Migranal), opioid medications and anti-
nausea drugs (such as chlorpromazine, metoclopramide (Reglan) or
prochlorperazine (Compro), taken along with pain medications. People who
experience frequent, long-lasting or severe headaches that do not respond
well to treatment may be asked to take preventive medications such as -
blood pressure-lowering medications, antidepressants, anti-seizure drugs
and Botox injections.
While administering treatment modalities to manage different types of
migraine symptoms, it is important for neurologists and other specialists to
document the modalities and other screening tests performed using the
correct medical codes. Medical billing services offered by reputable
medical billing companies help physicians use the correct ICD-10 codes for
their billing purposes.

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ICD-10 Codes for Migraines
G43 Migraine
 G43.0 Migraine without aura
 G43.00 Migraine without aura, not intractable
 G43.001 …… with status migrainosus
 G43.009 …… without status migrainosus
 G43.01 Migraine without aura, intractable
 G43.011 …… with status migrainosus
 G43.019 …… without status migrainosus
 G43.1 Migraine with aura
 G43.10 Migraine with aura, not intractable
 G43.101 …… with status migrainosus
 G43.109 …… without status migrainosus
 G43.11 Migraine with aura, intractable
 G43.111 …… with status migrainosus
 G43.119 …… without status migrainosus
 G43.4 Hemiplegic migraine
 G43.40 Hemiplegic migraine, not intractable
 G43.401 …… with status migrainosus
 G43.409 …… without status migrainosus
 G43.41 Hemiplegic migraine, intractable
 G43.411 …… with status migrainosus
 G43.419 …… without status migrainosus
 G43.5 Persistent migraine aura without cerebral infarction
 G43.50 Persistent migraine aura without cerebral infarction,
not intractable
 G43.501 …… with status migrainosus
 G43.509 …… without status migrainosus
 G43.51 Persistent migraine aura without cerebral infarction,
intractable
 G43.511 …… with status migrainosus
 G43.519 …… without status migrainosus
 G43.6 Persistent migraine aura with cerebral infarction
 G43.60 Persistent migraine aura with cerebral infarction, not
intractable
 G43.601 …… with status migrainosus
 G43.609 …… without status migrainosus

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 G43.61 Persistent migraine aura with cerebral infarction,
intractable
 G43.611 …… with status migrainosus
 G43.619 …… without status migrainosus
 G43.7 Chronic migraine without aura
 G43.70 Chronic migraine without aura, not intractable
 G43.701 …… with status migrainosus
 G43.709 …… without status migrainosus
 G43.71 Chronic migraine without aura, intractable
 G43.711 …… with status migrainosus
 G43.719 …… without status migrainosus
 G43.A Cyclical vomiting
 G43.A0 …… in migraine, not intractable
 G43.A1 …… in migraine, intractable
 G43.B Ophthalmoplegic migraine
 G43.B0 …… not intractable
 G43.B1 …… intractable
 G43.C Periodic headache syndromes in child or adult
 G43.C0 …… not intractable
 G43.C1 …… intractable
 G43.D Abdominal migraine
 G43.D0 …… not intractable
 G43.D1 …… intractable
 G43.8 Other migraine
 G43.80 Other migraine, not intractable
 G43.801 …… with status migrainosus
 G43.809 …… without status migrainosus
 G43.81 Other migraine, intractable
 G43.811 …… with status migrainosus
 G43.819 …… without status migrainosus
 G43.82 Menstrual migraine, not intractable
 G43.821 …… with status migrainosus
 G43.829 …… without status migrainosus
 G43.83 Menstrual migraine, intractable
 G43.831 …… with status migrainosus
 G43.839 …… without status migrainosus
 G43.9 Migraine, unspecified
 G43.90 Migraine, unspecified, not intractable

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 G43.901 …… with status migrainosus
 G43.909 …… without status migrainosus
 G43.91 Migraine, unspecified, intractable
 G43.911 …… with status migrainosus
 G43.919 …… without status migrainosus
Migraine prevention begins with avoiding triggers. It is important to learn
what triggers the migraine attack and take steps to avoid those things.
Making serious lifestyle alterations like – reducing stress, drinking plenty of
water, engaging in regular physical exercise, quitting smoking, avoiding the
habit of skipping meals, getting enough sleep and avoiding certain food
items can help reduce the frequency of migraines.
As physicians deal with the challenges of treating and preventing migraines,
they can rely on an experienced medical billing outsourcing company for
submitting claims on time and getting reimbursed for their services without
delay.