Neurology & Pain Management Coding Alert

ICD-10 Coding:

Know Other Headache Types to Master Dx Coding

Published on Thu Jun 15, 2023

Read on to discover characteristics of these headaches.

Everyone knows, or is at least familiar with, ICD-10 coding conventions for migraines. However, there are other headache-related diagnoses that you’ll see in your practice.

Check out this primer on some of the most common headaches you’ll see that aren’t related to migraines.

Look for ‘Cluster’ Period for These Headaches

One type of headache that you could see is a cluster headache, which is a type of severe, recurring headache that is characterized by intense, unilateral pain usually around the eye or temple. The headaches are cyclical or occur in clusters. Each headache can last from 15 minutes to three hours; a patient could get multiple headaches during a cluster period.

Other symptoms associated with cluster headaches include tearing, redness of the eye, nasal congestion, or a drooping eyelid on the affected side.

ICD-10: When a patient has a cluster headache, you’ll choose from the following codes:

G44.00- (Cluster headache syndrome, unspecified)
G44.01- (Episodic cluster headache)
G44.02- (Chronic cluster headache)

Notes: You’ll need to know the definition of chronic versus episodic to fully report these codes. A chronic headache typically involves at least 15 headache days a week for a period of three months. Episodic headaches occur less frequently than chronic headaches. Check with your payer if you have questions regarding what constitutes a chronic cluster headache.

You’ll also need to code to the 6th character to indicate whether the headache was intractable (“1”) or not intractable (“9”). An intractable headache is a severe and persistent headache that does not respond to traditional treatment methods. A not intractable headache responds well to typical treatment methods, such as over-the-counter pain relievers, rest, or other common headache therapies.

Dull Pain Often Linked to Tension-Type Headaches

Another non-migraine condition you’ll see is tension-type headaches. These headaches may occur when a person has high blood pressure (hypertension), but this is not a requirement to code for a tension-type headache. These headaches often feature a dull, throbbing, or pulsating pain, often on both sides of the head or at the back of the head.

Symptoms of these headaches include dizziness, blurred vision, and nosebleeds. Remember, however, that not everyone with high blood pressure will experience headaches, and having a headache does not necessarily indicate high blood pressure.

ICD-10: Report tension-type headaches with one of the following codes:

G44.20- (Tension-type headache, unspecified)
G44.21- (Episodic tension-type headache)
G44.22- (Chronic tension-type headache)

Notes: Like cluster headaches, tension-type headaches will make you choose episodic versus chronic (if possible). Further, you’ll also have to code to the 6th character to indicate intractable versus not intractable.

Injuries Often Lead to Post-Traumatic Headaches

If a patient suffers a headache after a head injury or trauma, such as concussion or whiplash, it could be a post-traumatic headache. These headaches can vary in intensity and duration.

Potential symptoms for post-traumatic headaches are numerous, and include a dull, throbbing, or sharp pain on one or both sides of the head. Further potential symptoms include dizziness, difficulty concentrating, sensitivity to light or sound, and changes in sleep patterns.

ICD-10: Choose from the following code sets for post-traumatic headaches:

G44.30- (Post-traumatic headache, unspecified)
G44.31- (Acute post-traumatic headache)
G44.32- (Chronic post-traumatic headache)

Notes: Remember to account for chronic/acute and tractable/ not intractable for your post-traumatic headache patients.

Complicated Headaches Have Their Own Code Set

ICD-10 also features a section devoted to complicated headache syndromes G44.5- (Complicated headache syndromes). Codes in this set are all for different types of complicated headaches. Check out a primer on the codes in this set.

Hemicrania continua: You’ll report hemicrania continua with G44.51 (Hemicrania continua). These are a rare type of chronic headache that usually feature continuous, unilateral head pain that varies in intensity. The affected side of the patient’s head can experience a constant, dull ache with occasional episodes of more severe pain.

Hemicrania continua is often associated with other symptoms such as tearing, redness of the eye, nasal congestion, or a drooping eyelid on the affected side.

NDPH: Another complicated headache syndrome in ICD-10 is new daily persistent headache (NDPH), which is a sudden-onset chronic headache that persists daily for at least three months. The pain is usually moderate to severe, and can be experienced unilaterally or bilaterally. The pain NDPH patients report is often described as a constant pressure-like or throbbing sensation.

Report NDPH with G44.52 (New daily persistent headache (NDPH)).

Thunderclap: If a patient suffers from headaches that manifest themselves quickly and last for days, it could be a thunderclap headache

A thunderclap headache is a severe type of headache that comes on suddenly and reaches its peak intensity within a minute. These headaches might last an hour or two, or could stretch through several days.

ICD-10: Report thunderclap headaches with G44.53 (Primary thunderclap headache).