A Migraine Is Not a Run-of-the-mill Headache

Differentiate migraines from common headaches for proper ICD-10-CM coding.

A migraine is more than just a headache. Although migraines are not completely understood, scientists believe the pain is caused by dilation and constriction of the cephalic blood vessels or a microembolism. What we do know is that not all migraines are the same, and diagnosis coding must reflect what the patient is experiencing.

Migraines Come with or without Auras

Migraines can last from four hours to several days and come in two forms: the common migraine (G43.0 Migraine without aura) and the classic migraine (G43.1 Migraine with aura). Classical migraines have been linked to higher incidences of cerebrovascular accidents and common migraines have a higher incidence of acute myocardial infarctions.
Common migraines are painful headaches that may or may not lead to vomiting, but will have:

• Photophobia (light sensitivity);
• Hyperacusis (a collapsed tolerance to usual environmental sounds); and
• Hyperosmia (heightened sense of smell).

Classic migraines have an aura at the beginning of the migraine. The aura signals the migraine is starting. An aura can be visual disturbances, confusion, excessive yawning and tiredness, hemiplegia (muscle paralysis affecting one half of the body), or dysphasia (trouble speaking). Each patient has their own type of aura.
After the aura, the headache begins, usually on one side of the head or the other. This headache can be described as pounding, ice picking, vice gripping, or throbbing. As time passes, the patient may feel nauseous and vomit. The vomiting may signal the end of the migraine is near, or it may not. Once the migraine ends, the patient may complain of a “migraine hangover.” The patient may be confused, struggle to find words, sluggish, and their head might feel bruised or painful when coughing or sneezing.

Prevention and Relief

Women are more likely than men to have migraines due to the hormonal changes a woman’s body goes through each month. The triggers are different for each patient: hormones, stress, chocolate, salt, an atrial septum defect, aged foods, etc. Migraines can also run in families, so there may be a genetic component.
Patients with migraines may need to keep a migraine journal to discover their triggers. They may try daily and/or onset medications. In recent decades medication for migraines has ranged from blood pressure medications to seizure disorder medications. In some patients, selective serotonin reuptake inhibitors (SSRIs) help by increasing the serotonin level, which has been noted to be lower in some migraine patients. Patients might also take magnesium daily to prevent migraines.
Some migraine sufferers try alternative medicine, such as massage, acupuncture, acupressure, or essential oils. Depending on the extent of the pain and how often the patient gets migraines, the patient may try just about anything to stop the pain.
 

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Kathy J. Ware

Kathy J. Ware, MCLS, RHIT, CPC, CPB, AAPC Instructor, is a professor of health information management at Lord Fairfax Community College. Her local chapters are both Winchester and Harrisonburg, Va. Wares has had both types of migraines since childhood.

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