Hemicrania continua
ICD-10 G44.51 is a billable code used to indicate a diagnosis of hemicrania continua.
Hemicrania continua is a chronic headache disorder characterized by unilateral, continuous pain that can fluctuate in intensity. The pain is typically moderate to severe and is often accompanied by features such as nausea, photophobia, and phonophobia. Unlike other headache disorders, hemicrania continua is unique in that it responds dramatically to indomethacin, a nonsteroidal anti-inflammatory drug (NSAID). The condition is more prevalent in women and can begin at any age, although it often presents in middle adulthood. Patients may experience exacerbations triggered by various factors, including stress, hormonal changes, and certain foods. Diagnosis is primarily clinical, relying on patient history and symptomatology, as there are no specific laboratory tests for hemicrania continua. The International Classification of Headache Disorders (ICHD) provides criteria for diagnosis, emphasizing the need for a thorough evaluation to rule out secondary causes of headache. Treatment typically involves pharmacological management, with indomethacin being the first-line therapy, and may include preventive treatments such as other NSAIDs or corticosteroids for patients who do not respond to indomethacin. Lifestyle modifications and avoidance of known triggers can also play a role in managing the condition.
Detailed headache history, including onset, duration, and associated symptoms; response to treatments; and any relevant imaging studies.
Patients presenting with chronic unilateral headaches, particularly those with a history of NSAID use.
Ensure clear documentation of the patient's response to indomethacin and any side effects experienced.
Comprehensive pain assessments, including pain scales, treatment plans, and patient-reported outcomes.
Patients seeking alternative treatments for chronic headache management.
Document any multimodal approaches to pain management and patient education on trigger avoidance.
Used for follow-up visits for patients with chronic headache management.
Document the patient's headache history, treatment response, and any changes in symptoms.
Neurologists should ensure detailed notes on headache characteristics and treatment adjustments.
The primary treatment for hemicrania continua is indomethacin, which is a nonsteroidal anti-inflammatory drug. Patients typically experience significant relief from their symptoms with this medication.
