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2025 ICD-10-CM code G44.4

Drug-induced headache, not elsewhere classified.

Use an additional code to specify the drug causing the headache if known.Do not use G44.4 if the headache is better explained by another diagnosis. If the patient has a primary headache disorder like migraine in addition to MOH, both codes should be reported.

Medical necessity must be established by demonstrating that the headaches are a direct result of medication overuse and not due to an underlying, untreated condition.The documentation must support a causal relationship between the medication use and the headaches. It should also include failed attempts to manage headaches through other means.

The diagnosis of drug-induced headache involves a thorough review of the patient's medication history, assessment of symptoms, clinical evaluation, and comparison with ICHD criteria. Treatment focuses on reducing or stopping the overused medication under medical supervision. Additional therapies such as cognitive behavioral therapy, biofeedback, and physical therapy may be beneficial.

IMPORTANT:Use an additional code to identify the specific drug causing the adverse effect (T36-T50 with fifth or sixth character 5).

In simple words: This refers to a headache caused by taking too much pain medication, even if taken as directed. It's also called a rebound headache because the pain may return worse when the medication wears off.It's common in people who already get headaches or migraines.

Drug-induced headache, not elsewhere classified, refers to a secondary headache caused by frequent use or excessive intake of medications such as narcotics, barbiturates (like butalbital), triptans, ergotamines, and even over-the-counter drugs like NSAIDs. This condition is also known as medication overuse headache, rebound headache, or medication misuse headache.It often develops in individuals with pre-existing headache disorders, like migraines or tension-type headaches, who overuse acute headache relief medications. According to the International Classification of Headache Disorders (ICHD), diagnostic criteria include headache present for more than 15 days per month for at least 3 months, developing or worsening during medication overuse.

Example 1: A patient with chronic migraines develops daily headaches after taking triptans for several months. The headaches are worse upon waking and improve temporarily with pain medication but return as the medication wears off. This scenario aligns with G44.4 because the patient’s headache developed/worsened due to medication overuse., A 45-year-old woman with a history of episodic tension headaches reports headaches on most days of the week. She frequently uses over-the-counter combination analgesics containing acetaminophen, aspirin, and caffeine. This falls under G44.4 given her frequent analgesic use., A patient with chronic back pain using opioid painkillers for an extended period develops daily headaches, along with nausea and difficulty concentrating. This is another scenario where medication overuse causes more frequent and severe headaches.

Documentation should include the type, frequency, and duration of headache; medication history, including the specific drugs, dosages, and duration of use; presence of any pre-existing headache disorders; and associated symptoms. Withdrawal symptoms upon discontinuation of the medication should be documented.

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