2025 ICD-10-CM code G43
(Valid) Effective Date: N/A Diseases of the nervous system - Migraine 6 Feed
Migraine. Use additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5).
Medical necessity for treatment of migraine is established by the presence of debilitating headaches that significantly impact the patient's quality of life. The frequency, severity, and associated symptoms should be documented.
Diagnosis of migraine is typically based on medical history, symptoms, and a physical and neurological exam. Imaging studies like MRI or CT scans, and blood or cerebrospinal fluid tests may be used. Treatment can include NSAIDs, triptans, ergot alkaloids, and sometimes narcotics for pain relief, as well as antiemetics for nausea and vomiting. Preventive medications such as beta blockers, antidepressants, antiseizure drugs, and erenumab may be prescribed. Lifestyle changes, rest, massage therapy, biofeedback, transcutaneous supraorbital nerve stimulation (t-SNS), and cognitive behavioral therapy (CBT) can also be helpful.
In simple words: A migraine is a severe, recurring headache that is often described as throbbing or pulsing. It typically affects one side of the head and can be accompanied by nausea, vomiting, and sensitivity to light. Some people experience visual or sensory disturbances (aura) before the headache begins.
Migraine. Note: the following terms are to be considered equivalent to intractable: pharmacoresistant (pharmacologically resistant), treatment resistant, refractory (medically) and poorly controlled. Use additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5). Excludes1: headache NOS (R51.9) lower half migraine (G44.00) Excludes2: headache syndromes (G44.-)
Example 1: A 35-year-old female presents with a throbbing headache on the right side of her head, accompanied by nausea and sensitivity to light. She reports similar headaches in the past, often triggered by stress.Diagnosis: G43 Migraine., A 20-year-old male experiences a severe headache with visual disturbances (aura) prior to onset. He has vomiting and photophobia. The headache lasts for two days. Diagnosis: G43 Migraine with aura., A 45-year-old female experiences recurrent episodes of one-sided headaches, usually lasting 1-2 days.She reports associated nausea, phonophobia, and photophobia. Diagnosis: G43 Migraine.
Documentation should include the type, severity, and frequency of headaches, associated symptoms (nausea, vomiting, aura), triggers, and response to treatment. Neurological exam findings should also be documented.
- Specialties:Neurology, Family Medicine, Internal Medicine, Pain Management
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Telehealth Provided in Patient’s Home, Telehealth Provided Other than in Patient’s Home