Name of the Condition

• Episodic Paroxysmal Hemicrania, Intractable
• Paroxysmal Hemicrania

Summary

Episodic Paroxysmal Hemicrania is a rare, severe headache disorder characterized by frequent, short-lasting attacks of unilateral head pain. Intractable means that standard treatments do not effectively alleviate the symptoms.

Causes

The exact cause of episodic paroxysmal hemicrania is not clearly understood. It is thought to be related to dysfunction in the autonomic nervous system or changes in specific neurotransmitters that regulate pain.

Risk Factors

• More common in women than men.
• No specific risk factors have been strongly associated, but it can appear without warning in adults.

Symptoms

• Severe, throbbing pain typically on one side of the head.
• Pain episodes lasting between 2 and 30 minutes.
• Can occur several times a day.
• Associated symptoms include tearing of the eye, nasal congestion, and eye redness on the affected side.

Diagnosis

• Clinical evaluation based on symptom description.
• Patient history of episodic headaches and response to treatment.
• MRI or CT scans may be conducted to rule out other conditions.

Treatment Options

• Indomethacin, a nonsteroidal anti-inflammatory drug (NSAID), is often effective but can be less so in intractable cases.
• Alternative treatments include other pain relief medications or occipital nerve blocks.
• Regular monitoring and adjusting medication strategies are essential.

Prognosis and Follow-Up

• Episodic attacks may persist over months or years.
• Many patients experience long periods without symptoms between attacks.
• Regular check-ups are critical to managing intractable cases and adjusting treatment plans.

Complications

• Persistent pain can lead to decreased quality of life.
• Risk of side effects from continuous medication use.

Lifestyle & Prevention

• Identifying and avoiding personal triggers, such as stress or specific foods.
• Maintaining a healthy lifestyle with regular exercise and adequate sleep.

When to Seek Professional Help

• If headaches become frequent or worsen over time.
• Lack of response to standard headache medications.
• New neurological symptoms such as vision changes or weakness.

Additional Resources

• National Headache Foundation: https://headaches.org
• American Migraine Foundation: https://americanmigrainefoundation.org

Tips for Medical Coders

• Ensure documentation specifies the nature of the headaches as intractable.
• Verify the presence of related symptoms and frequency of episodes for precise coding.
• Be cautious not to confuse with other headache types that have different ICD codes.