ICD-9 Code 346.63

Persistent migraine aura with cerebral infarction, with intractable migraine, so stated, with status migrainosus

Not Valid for Submission

346.63 is a legacy non-billable code used to specify a medical diagnosis of persistent migraine aura with cerebral infarction, with intractable migraine, so stated, with status migrainosus. This code was replaced on September 30, 2015 by its ICD-10 equivalent.

ICD-9: 346.63
Short Description:Prst ara w inf w ntr/st
Long Description:Persistent migraine aura with cerebral infarction, with intractable migraine, so stated, with status migrainosus

Convert 346.63 to ICD-10

The following crosswalk between ICD-9 to ICD-10 is based based on the General Equivalence Mappings (GEMS) information:

  • G43.611 - Perst migraine aura w cerebral infrc, ntrct, w stat migr

Code Classification

  • Diseases of the nervous system (320–359)
    • Other disorders of the central nervous system (340-349)
      • 346 Migraine

Information for Medical Professionals

Information for Patients


Migraine

What are migraines?

Migraines are a recurring type of headache. They cause moderate to severe pain that is throbbing or pulsing. The pain is often on one side of your head. You may also have other symptoms, such as nausea and weakness. You may be sensitive to light and sound.

What causes migraines?

Researchers believe that migraine has a genetic cause. There are also a number of factors that can trigger a migraine. These factors vary from person to person, and they include:

  • Stress
  • Anxiety
  • Hormonal changes in women
  • Bright or flashing lights
  • Loud noises
  • Strong smells
  • Medicines
  • Too much or not enough sleep
  • Sudden changes in weather or environment
  • Overexertion (too much physical activity)
  • Tobacco
  • Caffeine or caffeine withdrawal
  • Skipped meals
  • Medication overuse (taking medicine for migraines too often)

Some people have found that certain foods or ingredients can trigger headaches, especially when they are combined with other triggers. These foods and ingredients include:

  • Alcohol
  • Chocolate
  • Aged cheeses
  • Monosodium glutamate (MSG)
  • Some fruits and nuts
  • Fermented or pickled goods
  • Yeast
  • Cured or processed meats

Who is at risk for migraines?

About 12% of Americans get migraines. They can affect anyone, but you are more likely to have them if you:

  • Are a woman. Women are three times more likely than men to get migraines.
  • Have a family history of migraines. Most people with migraines have family members who have migraines.
  • Have other medical conditions, such as depression, anxiety, bipolar disorder, sleep disorders, and epilepsy.

What are the symptoms of migraines?

There are four different phases of migraines. You may not always go through every phase each time you have a migraine.:

  • Prodome. This phase starts up to 24 hours before you get the migraine. You have early signs and symptoms, such as food cravings, unexplained mood changes, uncontrollable yawning, fluid retention, and increased urination.
  • Aura. If you have this phase, you might see flashing or bright lights or zig-zag lines. You may have muscle weakness or feel like you are being touched or grabbed. An aura can happen just before or during a migraine.
  • Headache. A migraine usually starts gradually and then becomes more severe. It typically causes throbbing or pulsing pain, which is often on one side of your head. But sometimes you can have a migraine without a headache. Other migraine symptoms may include
    • Increased sensitivity to light, noise, and odors
    • Nausea and vomiting
    • Worsened pain when you move, cough, or sneeze
  • Postdrome (following the headache). You may feel exhausted, weak, and confused after a migraine. This can last up to a day.

Migraines are more common in the morning; people often wake up with them. Some people have migraines at predictable times, such as before menstruation or on weekends following a stressful week of work.

How are migraines diagnosed?

To make a diagnosis, your health care provider will:

  • Take your medical history
  • Ask about your symptoms
  • Do a physical and neurological exam

An important part of diagnosing migraines is to rule out other medical conditions which could be causing the symptoms. So you may also have blood tests, an MRI or CT scan, or other tests.

How are migraines treated?

There is no cure for migraines. Treatment focuses on relieving symptoms and preventing additional attacks.

There are different types of medicines to relieve symptoms. They include triptan drugs, ergotamine drugs, and pain relievers. The sooner you take the medicine, the more effective it is.

There are also other things you can do to feel better:

  • Resting with your eyes closed in a quiet, darkened room
  • Placing a cool cloth or ice pack on your forehead
  • Drinking fluids

There are some lifestyle changes you can make to prevent migraines:

  • Stress management strategies, such as exercise, relaxation techniques, and biofeedback, may reduce the number and severity of migraines. Biofeedback uses electronic devices to teach you to control certain body functions, such as your heartbeat, blood pressure, and muscle tension.
  • Make a log of what seems to trigger your migraines. You can learn what you need to avoid, such as certain foods and medicines. It also help you figure out what you should do, such as establishing a consistent sleep schedule and eating regular meals.
  • Hormone therapy may help some women whose migraines seem to be linked to their menstrual cycle
  • If you have obesity, losing weight may also be helpful

If you have frequent or severe migraines, you may need to take medicines to prevent further attacks. Talk with your health care provider about which drug would be right for you.

Certain natural treatments, such as riboflavin (vitamin B2) and coenzyme Q10, may help prevent migraines. If your magnesium level is low, you can try taking magnesium. There is also an herb, butterbur, which some people take to prevent migraines. But butterbur may not be safe for long-term use. Always check with your health care provider before taking any supplements.

NIH: National Institute of Neurological Disorders and Stroke


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Stroke

What is a stroke?

A stroke happens when there is a loss of blood flow to part of the brain. Your brain cells cannot get the oxygen and nutrients they need from blood, and they start to die within a few minutes. This can cause lasting brain damage, long-term disability, or even death.

If you think that you or someone else is having a stroke, call 911 right away. Immediate treatment may save someone's life and increase the chances for successful rehabilitation and recovery.

What are the types of stroke?

There are two types of stroke:

  • Ischemic stroke is caused by a blood clot that blocks or plugs a blood vessel in the brain. This is the most common type; about 80% of strokes are ischemic.
  • Hemorrhagic stroke is caused by a blood vessel that breaks and bleeds into the brain

Another condition that's similar to a stroke is a transient ischemic attack (TIA). It's sometimes called a "mini-stroke." TIAs happen when the blood supply to the brain is blocked for a short time. The damage to the brain cells isn't permanent, but if you have had a TIA, you are at a much higher risk of having a stroke.

Who is at risk for a stroke?

Certain factors can raise your risk of a stroke. The major risk factors include:

  • High blood pressure. This is the primary risk factor for a stroke.
  • Diabetes.
  • Heart diseases. Atrial fibrillation and other heart diseases can cause blood clots that lead to stroke.
  • Smoking. When you smoke, you damage your blood vessels and raise your blood pressure.
  • A personal or family history of stroke or TIA.
  • Age. Your risk of stroke increases as you get older.
  • Race and ethnicity. African Americans have a higher risk of stroke.

There are also other factors that are linked to a higher risk of stroke, such as:

  • Alcohol and illegal drug use
  • Not getting enough physical activity
  • High cholesterol
  • Unhealthy diet
  • Having obesity

What are the symptoms of stroke?

The symptoms of stroke often happen quickly. They include:

  • Sudden numbness or weakness of the face, arm, or leg (especially on one side of the body)
  • Sudden confusion, trouble speaking, or understanding speech
  • Sudden trouble seeing in one or both eyes
  • Sudden difficulty walking, dizziness, loss of balance or coordination
  • Sudden severe headache with no known cause

If you think that you or someone else is having a stroke, call 911 right away.

How are strokes diagnosed?

To make a diagnosis, your health care provider will:

  • Ask about your symptoms and medical history
  • Do a physical exam, including a check of
    • Your mental alertness
    • Your coordination and balance
    • Any numbness or weakness in your face, arms, and legs
    • Any trouble speaking and seeing clearly
  • Run some tests, which may include
    • Diagnostic imaging of the brain, such as a CT scan or MRI
    • Heart tests, which can help detect heart problems or blood clots that may have led to a stroke. Possible tests include an electrocardiogram (EKG) and an echocardiography.

What are the treatments for stroke?

Treatments for stroke include medicines, surgery, and rehabilitation. Which treatments you get depend on the type of stroke and the stage of treatment. The different stages are:

  • Acute treatment, to try to stop a stroke while it is happening
  • Post-stroke rehabilitation, to overcome the disabilities caused by the stroke
  • Prevention, to prevent a first stroke or, if you have already had one, prevent another stroke

Acute treatments for ischemic stroke are usually medicines:

  • You may get tPA, (tissue plasminogen activator), a medicine to dissolve the blood clot. You can only get this medicine within 4 hours of when your symptoms started. The sooner you can get it, the better your chance of recovery.
  • If you cannot get that medicine, you may get medicine that helps stop platelets from clumping together to form blood clots. Or you may get a blood thinner to keep existing clots from getting bigger.
  • If you have carotid artery disease, you may also need a procedure to open your blocked carotid artery

Acute treatments for hemorrhagic stroke focus on stopping the bleeding. The first step is to find the cause of bleeding in the brain. The next step is to control it:

  • If high blood pressure is the cause of bleeding, you may be given blood pressure medicines.
  • If an aneurysm if the cause, you may need aneurysm clipping or coil embolization. These are surgeries to prevent further leaking of blood from the aneurysm. It also can help prevent the aneurysm from bursting again.
  • If an arteriovenous malformation (AVM) is the cause of a stroke, you may need an AVM repair. An AVM is a tangle of faulty arteries and veins that can rupture within the brain. An AVM repair may be done through
    • Surgery
    • Injecting a substance into the blood vessels of the AVM to block blood flow
    • Radiation to shrink the blood vessels of the AVM

Stroke rehabilitation can help you relearn skills you lost because of the damage. The goal is to help you become as independent as possible and to have the best possible quality of life.

Prevention of another stroke is also important, since having a stroke increases the risk of getting another one. Prevention may include heart-healthy lifestyle changes and medicines.

Can strokes be prevented?

If you have already had a stroke or are at risk of having a stroke, you can make some heart-healthy lifestyle changes to try to prevent a future stroke:

  • Eating a heart-healthy diet
  • Aiming for a healthy weight
  • Managing stress
  • Getting regular physical activity
  • Quitting smoking
  • Managing your blood pressure and cholesterol levels

If these changes aren't enough, you may need medicine to control your risk factors.

NIH: National Institute of Neurological Disorders and Stroke


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ICD-9 Footnotes

General Equivalence Map Definitions
The ICD-9 and ICD-10 GEMs are used to facilitate linking between the diagnosis codes in ICD-9-CM and the new ICD-10-CM code set. The GEMs are the raw material from which providers, health information vendors and payers can derive specific applied mappings to meet their needs.

  • Approximate Flag - The approximate flag is on, indicating that the relationship between the code in the source system and the code in the target system is an approximate equivalent.
  • No Map Flag - The no map flag indicates that a code in the source system is not linked to any code in the target system.
  • Combination Flag - The combination flag indicates that more than one code in the target system is required to satisfy the full equivalent meaning of a code in the source system.