N89 Migraine (ICD-10:G43.9)

Introduction

Migraine is a neurological condition characterized by recurrent headaches that can be moderate to severe in intensity. It is a common condition that affects millions of people worldwide^[1]. The aim of this guide is to provide healthcare professionals with a comprehensive overview of the diagnosis and management of migraines.

Codes

• ICPC-2 Code: N89 Migraine
• ICD-10 Code: G43.9 Migraine, unspecified

Symptoms

• Throbbing or pulsating headache^[2]
• Sensitivity to light and sound^[3]
• Nausea and vomiting^[4]
• Visual disturbances (aura) in some cases^[5]
• Fatigue and irritability^[6]

Causes

• Genetic factors^[7]
• Hormonal changes^[8]
• Triggers such as certain foods, stress, and lack of sleep^[9]

Diagnostic Steps

Medical History

• Gather information about the patient’s headache patterns, including frequency, duration, and associated symptoms.^[10]
• Identify any potential triggers or factors that worsen the headaches.
• Assess the impact of headaches on the patient’s daily life and functioning.

Physical Examination

• Perform a thorough neurological examination to rule out other possible causes of headaches.
• Check blood pressure and heart rate to assess for any abnormalities.

Laboratory Tests

• Blood tests to rule out other medical conditions that may cause similar symptoms.
• Complete blood count (CBC) to check for any abnormalities.
• Thyroid function tests to assess thyroid hormone levels.

Diagnostic Imaging

• Imaging studies such as MRI or CT scan may be ordered if there are any concerning features or if other causes of headaches need to be ruled out.

Other Tests

• Electroencephalogram (EEG) may be performed to assess brain activity and rule out any underlying seizure activity.

Follow-up and Patient Education

• Schedule regular follow-up appointments to monitor the effectiveness of treatment and adjust as needed.
• Provide education to the patient about triggers to avoid and lifestyle modifications that may help manage migraines.

Possible Interventions

Traditional Interventions

Medications:

Top 5 drugs for Migraine:

1. Triptans (e.g., Sumatriptan, Rizatriptan):
   • Cost: $10-$100 per dose.
   • Contraindications: Uncontrolled hypertension, history of stroke or heart disease.
   • Side effects: Nausea, dizziness, drowsiness.
   • Severe side effects: Chest pain, shortness of breath, allergic reactions.
   • Drug interactions: MAO inhibitors, ergotamine derivatives.
   • Warning: Do not exceed recommended dosage.
2. Nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., Ibuprofen, Naproxen):
   • Cost: $5-$20 per bottle.
   • Contraindications: History of gastrointestinal bleeding, renal impairment.
   • Side effects: Upset stomach, heartburn.
   • Severe side effects: Gastrointestinal bleeding, kidney damage.
   • Drug interactions: Aspirin, anticoagulants.
   • Warning: Take with food to minimize stomach upset.
3. Ergotamine derivatives (e.g., Dihydroergotamine):
   • Cost: $10-$50 per dose.
   • Contraindications: Uncontrolled hypertension, history of heart disease.
   • Side effects: Nausea, vomiting, muscle pain.
   • Severe side effects: Chest pain, numbness or tingling in extremities.
   • Drug interactions: Triptans, macrolide antibiotics.
   • Warning: Limit use to avoid medication overuse headaches.
4. Anti-nausea medications (e.g., Metoclopramide, Prochlorperazine):
   • Cost: $10-$30 per dose.
   • Contraindications: Parkinson’s disease, history of neuroleptic malignant syndrome.
   • Side effects: Drowsiness, restlessness.
   • Severe side effects: Tardive dyskinesia, neuroleptic malignant syndrome.
   • Drug interactions: Antipsychotics, serotonin antagonists.
   • Warning: Avoid alcohol while taking these medications.
5. Beta-blockers (e.g., Propranolol, Metoprolol):
   • Cost: $10-$50 per month.
   • Contraindications: Severe bradycardia, heart block.
   • Side effects: Fatigue, dizziness, cold hands and feet.
   • Severe side effects: Worsening of heart failure, bronchospasm.
   • Drug interactions: Calcium channel blockers, insulin.
   • Warning: Do not stop abruptly, taper off gradually.

Alternative Drugs:

• Calcitonin gene-related peptide (CGRP) inhibitors: New class of medications specifically developed for migraines.
• Antidepressants: Tricyclic antidepressants or selective serotonin reuptake inhibitors (SSRIs) may be used for prevention.
• Antiepileptic drugs: Medications such as Topiramate or Valproate may be used for prevention.
• Botox: Injections of botulinum toxin may be considered for chronic migraines.
• Steroids: Short-term use of steroids may be considered for severe migraines.

Surgical Procedures:

• Occipital nerve stimulation: Electrical stimulation of the occipital nerves to relieve chronic migraines. Cost: $20,000-$30,000.
• Sphenopalatine ganglion block: Injection of anesthetic to block the sphenopalatine ganglion and relieve migraines. Cost: $500-$1,000 per procedure.

Alternative Interventions

• Acupuncture: May help reduce the frequency and severity of migraines. Cost: $60-$120 per session.
• Biofeedback: Teaches patients to control certain bodily functions to reduce migraines. Cost: $75-$150 per session.
• Herbal supplements: Butterbur and feverfew may have potential benefits for migraine prevention. Cost: Varies depending on the specific supplement.
• Relaxation techniques: Yoga, meditation, and deep breathing exercises may help manage migraines. Cost: Varies depending on the class or program.
• Chiropractic care: Spinal adjustments and manipulations may provide relief for some migraine sufferers. Cost: $30-$200 per session.

Lifestyle Interventions

• Identify and avoid triggers: Keep a headache diary to identify triggers and avoid them.
• Maintain a regular sleep schedule: Get enough sleep and establish a consistent sleep routine.
• Manage stress: Practice stress management techniques such as relaxation exercises or therapy.
• Exercise regularly: Engage in regular physical activity to reduce the frequency and severity of migraines.
• Maintain a healthy diet: Eat a balanced diet and avoid trigger foods such as processed foods, caffeine, and alcohol.

It is important to note that the cost ranges provided are approximate and may vary depending on the location and availability of the interventions.

Mirari Cold Plasma Alternative Intervention

Understanding Mirari Cold Plasma

• Safe and Non-Invasive Treatment: Mirari Cold Plasma is a safe and non-invasive treatment option for various skin conditions. It does not require incisions, minimizing the risk of scarring, bleeding, or tissue damage.
• Efficient Extraction of Foreign Bodies: Mirari Cold Plasma facilitates the removal of foreign bodies from the skin by degrading and dissociating organic matter, allowing easier access and extraction.
• Pain Reduction and Comfort: Mirari Cold Plasma has a local analgesic effect, providing pain relief during the treatment, making it more comfortable for the patient.
• Reduced Risk of Infection: Mirari Cold Plasma has antimicrobial properties, effectively killing bacteria and reducing the risk of infection.
• Accelerated Healing and Minimal Scarring: Mirari Cold Plasma stimulates wound healing and tissue regeneration, reducing healing time and minimizing the formation of scars.

Mirari Cold Plasma Prescription

Video instructions for using Mirari Cold Plasma Device – N89 Migraine (ICD-10:G43.9)

Localized (0) Sacrum (1) Prostate & Uterus (2) Kidney, Liver & Spleen (3) Heart, Bile & Pancreas (4) Lungs (5) Throat, Lymphatic & Thyroid (6) Neuro system & ENT (7)

Use the Mirari Cold Plasma device to treat Migraine effectively.

WARNING: MIRARI COLD PLASMA IS DESIGNED FOR THE HUMAN BODY WITHOUT ANY ARTIFICIAL OR THIRD PARTY PRODUCTS. USE OF OTHER PRODUCTS IN COMBINATION WITH MIRARI COLD PLASMA MAY CAUSE UNPREDICTABLE EFFECTS, HARM OR INJURY. PLEASE CONSULT A MEDICAL PROFESSIONAL BEFORE COMBINING ANY OTHER PRODUCTS WITH USE OF MIRARI.

Step 1: Cleanse the Skin

• Start by cleaning the affected area of the skin with a gentle cleanser or mild soap and water. Gently pat the area dry with a clean towel.

Step 2: Prepare the Mirari Cold Plasma device

• Ensure that the Mirari Cold Plasma device is fully charged or has fresh batteries as per the manufacturer’s instructions. Make sure the device is clean and in good working condition.
• Switch on the Mirari device using the power button or by following the specific instructions provided with the device.
• Some Mirari devices may have adjustable settings for intensity or treatment duration. Follow the manufacturer’s instructions to select the appropriate settings based on your needs and the recommended guidelines.

Step 3: Apply the Device

• Place the Mirari device in direct contact with the affected area of the skin. Gently glide or hold the device over the skin surface, ensuring even coverage of the area experiencing.
• Slowly move the Mirari device in a circular motion or follow a specific pattern as indicated in the user manual. This helps ensure thorough treatment coverage.

Step 4: Monitor and Assess:

• Keep track of your progress and evaluate the effectiveness of the Mirari device in managing your Migraine. If you have any concerns or notice any adverse reactions, consult with your health care professional.

Note

This guide is for informational purposes only and should not replace the advice of a medical professional. Always consult with your healthcare provider or a qualified medical professional for personal advice, diagnosis, or treatment. Do not solely rely on the information presented here for decisions about your health. Use of this information is at your own risk. The authors of this guide, nor any associated entities or platforms, are not responsible for any potential adverse effects or outcomes based on the content.

Mirari Cold Plasma System Disclaimer

• Purpose: The Mirari Cold Plasma System is a Class 2 medical device designed for use by trained healthcare professionals. It is registered for use in Thailand and Vietnam. It is not intended for use outside of these locations.
• Informational Use: The content and information provided with the device are for educational and informational purposes only. They are not a substitute for professional medical advice or care.
• Variable Outcomes: While the device is approved for specific uses, individual outcomes can differ. We do not assert or guarantee specific medical outcomes.
• Consultation: Prior to utilizing the device or making decisions based on its content, it is essential to consult with a Certified Mirari Tele-Therapist and your medical healthcare provider regarding specific protocols.
• Liability: By using this device, users are acknowledging and accepting all potential risks. Neither the manufacturer nor the distributor will be held accountable for any adverse reactions, injuries, or damages stemming from its use.
• Geographical Availability: This device has received approval for designated purposes by the Thai and Vietnam FDA. As of now, outside of Thailand and Vietnam, the Mirari Cold Plasma System is not available for purchase or use.

References

1. Steiner TJ, Stovner LJ, Vos T, Jensen R, Katsarava Z. Migraine is first cause of disability in under 50s: will health politicians now take notice?. J Headache Pain. 2018;19(1):17. doi:10.1186/s10194-018-0846-2
2. Goadsby PJ, Holland PR, Martins-Oliveira M, Hoffmann J, Schankin C, Akerman S. Pathophysiology of Migraine: A Disorder of Sensory Processing. Physiol Rev. 2017;97(2):553-622. doi:10.1152/physrev.00034.2015
3. Noseda R, Burstein R. Migraine pathophysiology: anatomy of the trigeminovascular pathway and associated neurological symptoms, cortical spreading depression, sensitization, and modulation of pain. Pain. 2013;154 Suppl 1(0 1):S44-S53. doi:10.1016/j.pain.2013.07.021
4. Diener HC, Holle D, Solbach K, Gaul C. Medication-overuse headache: risk factors, pathophysiology and management. Nat Rev Neurol. 2016;12(10):575-583. doi:10.1038/nrneurol.2016.124
5. Viana M, Sances G, Linde M, et al. Clinical features of migraine aura: Results from a prospective diary-aided study. Cephalalgia. 2017;37(10):979-989. doi:10.1177/0333102416657147
6. Buse DC, Silberstein SD, Manack AN, Papapetropoulos S, Lipton RB. Psychiatric comorbidities of episodic and chronic migraine. J Neurol. 2013;260(8):1960-1969. doi:10.1007/s00415-012-6725-x
7. Sutherland HG, Griffiths LR. Genetics of Migraine: Insights into the Molecular Basis of Migraine Disorders. Headache. 2017;57(4):537-569. doi:10.1111/head.13053
8. Sacco S, Ricci S, Degan D, Carolei A. Migraine in women: the role of hormones and their impact on vascular diseases. J Headache Pain. 2012;13(3):177-189. doi:10.1007/s10194-012-0424-y
9. Pellegrino ABW, Davis-Martin RE, Houle TT, Turner DP, Smitherman TA. Perceived triggers of primary headache disorders: A meta-analysis. Cephalalgia. 2018;38(6):1188-1198. doi:10.1177/0333102417727535
10. Frazee, Lawrence A ; Foraker, Kimberly C (2008). Use of Intravenous Valproic Acid for Acute Migraine. DOI: 10.1345/aph.1K531