D22.9 - Melanocytic nevi, unspecified

Clinical Definition

A severe headache episode occurring on only one side of the head, accompanied by autonomic symptoms like nasal congestion or eye tearing, that typically lasts 15-180 minutes. Cluster headaches characteristically occur in cyclical patterns or clusters, often waking patients at similar times of night.

Documentation Requirements

• Duration of individual attacks (typically 15-180 minutes)

• Frequency of episodes per day/week

• Current cluster period status (active vs. remission)

• Side of head affected (laterality)

• Associated symptoms must include at least one:

  • Conjunctival injection and/or lacrimation

  • Nasal congestion and/or rhinorrhea

  • Eyelid edema

  • Facial sweating

  • Miosis and/or ptosis

• Severity level (typically described as severe or very severe)

• Pattern/timing of attacks

• Duration of cluster periods

Common Synonyms

• Suicide headache

• Alarm clock headache

• Histamine headache

• "Ice pick" headache

• Horton's syndrome

Coding Conflicts

Excludes1:

• Migraine (G43.-)

• Trigeminal neuralgia (G50.0)

• Chronic paroxysmal hemicrania (G44.51)

Scribing.io Automation

Scribing.io's AI automatically identifies key cluster headache indicators in patient narratives by detecting:

• Temporal patterns ("occurs at same time every night")

• Unilateral pain descriptions

• Autonomic features

• Duration specifics

• Cyclical nature of episodes
  The system flags missing documentation elements required for coding specificity and prompts providers to complete needed details through smart templates.