Find information on documenting a history of migraine in healthcare settings. This resource covers clinical documentation, medical coding (ICD-10), migraine diagnosis criteria, and best practices for recording patient history related to migraine headaches, including frequency, severity, aura, and triggers. Learn about accurately capturing migraine history for optimal patient care and accurate billing.
Also known as
Migraine
Covers all types of migraine and related symptoms.
Other headache syndromes
Includes other headache types that may be related to or mistaken for migraine.
Headache
A general code for headache, useful if the specific type is uncertain or undocumented.
Follow this step-by-step guide to choose the correct ICD-10 code.
Is the migraine current/active?
Yes
Do NOT code history of migraine. Code the active migraine (G43.x).
No
Is there status migrainosus?
When to use each related code
| Description |
|---|
| History of Migraine |
| Migraine without Aura |
| Migraine with Aura |
Coding G43.909, migraine unspecified, without adequate documentation of migraine type (with/without aura) impacts reimbursement and data accuracy.
Failing to capture status migrainosus (G43.11x) when documented leads to undercoding severity and lost revenue.
Missing related diagnoses like aura (G43.10x), ophthalmoplegic migraine (G43.81x), or chronic migraine (G43.409) affects risk adjustment and quality metrics.
Q: How can I differentiate between migraine with aura and other neurological conditions mimicking migraine aura symptoms in my differential diagnosis?
A: Differentiating migraine with aura from other neurological conditions requires a thorough clinical evaluation. Consider the temporal profile of the aura, which in migraine typically evolves gradually over minutes and lasts less than 60 minutes. Visual auras in migraine are often positive (e.g., scintillations, fortification spectra) rather than negative (e.g., scotoma). Sensory symptoms in migraine aura typically spread gradually over the body. Transient ischemic attacks (TIAs) can mimic migraine aura, but TIAs usually present with negative symptoms and abrupt onset. Epileptic auras can also be confused with migraine aura, but epileptic auras may involve other symptoms like automatisms or loss of awareness. A detailed history focusing on symptom characteristics, duration, and frequency, combined with a neurological examination, is crucial. Neuroimaging may be indicated if the presentation is atypical or concerning for other pathologies. Consider implementing standardized diagnostic criteria for migraine with aura (e.g., ICHD-3) to enhance diagnostic accuracy. Explore how detailed symptom documentation can help distinguish migraine aura from other conditions.
Q: What are the best evidence-based strategies for managing chronic migraine in patients with a complex medical history, including comorbidities like anxiety and depression?
A: Managing chronic migraine in patients with comorbidities requires a multifaceted approach. Address both the migraine and the comorbid conditions concurrently, as they often influence each other. Evidence-based pharmacological options include antidepressants like tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs), anticonvulsants like topiramate and valproate, and CGRP monoclonal antibodies. Non-pharmacological strategies, such as cognitive behavioral therapy (CBT), biofeedback, and stress management techniques, can be beneficial. Explore how integrating lifestyle modifications, including regular sleep, exercise, and dietary changes, can contribute to overall migraine management. Consider implementing a patient-centered approach, involving shared decision-making and addressing individual patient preferences and needs. Learn more about the interplay between migraine, anxiety, and depression to tailor your management strategy effectively.
Patient presents with a history of migraine headaches, fulfilling the diagnostic criteria for ICHD-3. The patient reports recurrent episodes of moderate to severe, typically unilateral, pulsating head pain, often aggravated by routine physical activity. Migraine attacks are frequently associated with nausea, photophobia, and phonophobia. Aura is reported in some instances, characterized by visual disturbances such as scintillating scotoma or fortification spectra, preceding the headache phase. Triggers identified by the patient include stress, caffeine withdrawal, and changes in sleep patterns. Family history is positive for migraine headaches. The patient's headache frequency varies, averaging two to three migraine days per month. Previous treatments have included over-the-counter analgesics like ibuprofen and naproxen sodium, with limited efficacy. Triptans have not been previously prescribed. A neurological examination was normal, with no focal neurological deficits. Impression: History of migraine with aura. Plan: Initiate prophylactic therapy with propranolol and prescribe sumatriptan as an abortive medication. Patient education on migraine triggers, management strategies, and the importance of maintaining a headache diary was provided. Follow-up scheduled in four weeks to assess treatment response and adjust therapy as needed. ICD-10 code G43.10, migraine without aura, and G43.11, migraine with aura, are considered depending on the specific episode documentation. CPT codes for the evaluation and management visit will be determined based on the complexity of the encounter, including time spent with the patient and medical decision making. Differential diagnosis includes tension-type headache, cluster headache, and secondary headache disorders. Referral to neurology may be considered if the patient fails to respond to initial treatment or experiences an escalation in headache frequency or severity.