Migraines – Types, Diagnosis, Treatment and Prevention

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. Outsource Strategies International 8596 E. 101st Street, Suite H Tulsa, OK 74133

2. 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 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 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. affects 39 million fully understood, genetics and 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 www.outsourcestrategies.com 918-221-7769

3. 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 www.outsourcestrategies.com 918-221-7769

4. 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 www.outsourcestrategies.com 918-221-7769

5. 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. www.outsourcestrategies.com 918-221-7769

6. 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 www.outsourcestrategies.com 918-221-7769

7. 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 www.outsourcestrategies.com 918-221-7769

8. 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. www.outsourcestrategies.com 918-221-7769