From the Guidelines
The ICD-10 codes for common headache disorders include G43 for migraines, G44.0 for cluster headaches, G44.1 for vascular headaches, G44.2 for tension-type headaches, and R51 for unspecified headaches. Treatment options vary by headache type. For migraines, acute treatments include NSAIDs (ibuprofen 400-600mg or naproxen 500-550mg), triptans (sumatriptan 50-100mg orally or 6mg subcutaneously), and antiemetics (metoclopramide 10mg) for associated nausea, as recommended by the American College of Physicians 1.
- Key considerations for treatment include: + Using combination therapy, such as a triptan with an NSAID or acetaminophen, to improve efficacy 2 + Considering CGRP antagonists-gepants (rimegepant, ubrogepant, or zavegepant) or ergot alkaloid (dihydroergotamine) for moderate to severe acute episodic migraine headache in nonpregnant outpatient adults who do not tolerate or have inadequate response to combination therapy 3 + Avoiding opioids or butalbital for the treatment of acute episodic migraine 4 + Counseling patients to begin treatment of migraine headache as soon as possible after its onset, and to be aware of medication overuse headache, which is a potential complication of migraine treatment 5 Preventive treatments for frequent migraines include propranolol (40-240mg daily), topiramate (25-200mg daily), amitriptyline (10-150mg nightly), and newer CGRP antagonists like erenumab (70-140mg monthly injection) 1.
- Tension headaches typically respond to NSAIDs, while cluster headaches require high-flow oxygen (12-15L/min), injectable sumatriptan, or intranasal lidocaine for acute attacks, with verapamil (240-480mg daily) for prevention.
- Medication overuse headaches (G44.4) require withdrawal of the overused medication and transitional therapy. Proper headache diagnosis is essential for effective treatment, as different headache types respond to specific therapies based on their distinct pathophysiological mechanisms.
From the Research
ICD-10 Codes for Headaches
- The ICD-10 codes for headaches are as follows: + G43: Migraine + G44: Other headache syndromes + R51: Headache
Treatment Options for Different Types of Headaches
- Migraine: First-line acute treatment for migraine consists of analgesics, triptans, and antiemetics 6. Preventive therapy for migraine can include β-blockers, tricyclics, antiepileptics, and botulinum toxin 6.
- Tension-Type Headache (TTH): Simple analgesics are widely regarded as first-line medications for the acute treatment of TTH 7. Preventive treatment for TTH can include amitriptyline, venlafaxine, and mirtazapine 7.
- Post-Traumatic Headache (PTH): Acute/preemptive pharmacological treatments for PTH include drugs used for migraine and TTH 8. Multimodal non-pharmacologic approaches, which account for comorbidities and biopsychosocial factors, are often used in PTH patients 8.
- Cluster Headache: The onset of cluster headache in close temporal relation to a head trauma has only been described in rare cases 9.
Diagnosis of Headaches
- Diagnosis of headaches is based on headache history and the exclusion of alternative diagnoses, with clinical criteria provided by the International Classification of Headache Disorders, third edition 7.
- Migraine is associated with significant work- and family-related disability, and is often underdiagnosed 10.
- Barriers to appropriate treatment of migraine include lack of access to providers, misdiagnosis, and acute and preventive therapies not being prescribed 10.