G43.419 Hemiplegic migraine, intractable, without status migrainosus

ICD10CM code

#### Name of the Condition
- Hemiplegic Migraine, Intractable, Without Status Migrainosus

#### Summary
A hemiplegic migraine is a rare form of migraine that includes temporary weakness or paralysis on one side of the body, often accompanied by migraine headaches. The term "intractable" refers to migraines that do not respond well to standard treatments, and "without status migrainosus" indicates that the migraine attack lasts less than 72 hours.

#### Causes
The exact cause is not fully understood, but it is believed to have genetic components. Mutations in specific genes such as ATP1A2, CACNA1A, and SCN1A are linked to familial cases.

#### Risk Factors
- Family history of hemiplegic migraines.
- Female gender (more common than in males).
- Previous history of migraines.

#### Symptoms
- Severe headache (often on one side).
- Temporary hemiplegia (weakness or paralysis on one side of the body).
- Aura symptoms (visual disturbances, speech difficulties).
- Nausea and vomiting.
- Sensitivity to light and sound.

#### Diagnosis
- Clinical evaluation based on symptoms.
- Neurological examination.
- Genetic testing may be considered for familial cases.
- Brain imaging (CT or MRI) to rule out other conditions.

#### Treatment Options
- Acute treatment with medications like NSAIDs or triptans (with caution due to symptomatic overlap).
- Preventive medications like calcium channel blockers or anticonvulsants.
- Physical therapy to manage paralysis.

#### Prognosis and Follow-Up
- Symptoms typically resolve after a few hours to a day or two but can recur.
- Regular monitoring by a neurologist is advised to manage symptoms effectively.
- Ongoing research aims to improve treatment outcomes.

#### Complications
- Residual neurological symptoms.
- Increased risk of ischemic stroke.
- Impact on quality of life due to frequent and severe attacks.

#### Lifestyle & Prevention
- Stress management through relaxation techniques.
- Regular sleep schedule and hydration.
- Avoidance of known migraine triggers (e.g., certain foods, bright lights).

#### When to Seek Professional Help
- Sudden onset of severe headache with paralysis.
- Headaches accompanied by unusual neurological symptoms.
- Symptoms lasting longer than expected or recurring frequently.

#### Additional Resources
- American Migraine Foundation (www.americanmigrainefoundation.org)
- National Headache Foundation (www.headaches.org)

#### Tips for Medical Coders
- Ensure specificity: Note the "intractable" and "without status migrainosus" aspects.
- Verify the correct anatomical side affected if stated.
- Avoid confusing with other types of migraines or neurological conditions.

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