G43.40 - Hemiplegic migraine, not intractable

Specific Coding for Hemiplegic migraine, not intractable

Non-specific codes like G43.40 require more digits to indicate the appropriate level of specificity. Consider using any of the following ICD-10 codes with a higher level of specificity when coding for hemiplegic migraine, not intractable:

Patient Education

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

Sporadic hemiplegic migraine

Sporadic hemiplegic migraine is a rare form of migraine headache. Migraines typically cause intense, throbbing pain in one area of the head. Some people with migraines also experience nausea, vomiting, and sensitivity to light and sound. These recurrent headaches typically begin in childhood or adolescence and can be triggered by certain foods, emotional stress, and minor head trauma. Each headache may last from a few hours to a few days.

In sporadic hemiplegic migraine and some other types of migraine, a pattern of neurological symptoms called an aura occurs before onset of the headache. An aura commonly includes temporary visual changes such as blind spots (scotomas), flashing lights, zig-zagging lines, and double vision. In people with sporadic hemiplegic migraine, auras are also characterized by temporary numbness or weakness, often affecting one side of the body (hemiparesis). Additional features of an aura can include difficulty with speech, confusion, and drowsiness. An aura typically develops gradually over a few minutes and lasts about an hour.

Some people with sporadic hemiplegic migraine experience unusually severe migraine episodes. These episodes can include fever, prolonged weakness, seizures, and coma. Although most people with sporadic hemiplegic migraine recover completely between episodes, neurological symptoms such as memory loss and problems with attention can last for weeks or months. Some affected individuals develop mild but permanent difficulty coordinating movements (ataxia), which may worsen with time, and rapid, involuntary eye movements called nystagmus. Mild to severe intellectual disability has been reported in some people with sporadic hemiplegic migraine.

Code History

• FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023
• FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022
• FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
• FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
• FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
• FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
• FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
• FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016 (First year ICD-10-CM implemented into the HIPAA code set)