Bilateral facial numbness. Synonyms: autoimmune movement disorder, circumoral paresthesia, facial diplegia with Abstract Bilateral paralysis of the facial nerve is a relatively rare presentation and often indicates a serious underlying medical condition. NICE guidance on sensory symptoms in adults covers rapid stroke assessment, urgent referrals for pattern numbness, and key neuro conditions including migraine with aura and peripheral Cervical radiculopathy which can include pins-and-needles tingling, numbness, problems with reflexes, and/or weakness that goes into the shoulder, arm, hand, Unilateral or bilateral facial numbness Associated symptoms such as weakness, tingling, or pain History of recent infections, trauma, or neurological disorders Symptoms may include gait disturbances, coordination difficulties, clumsiness, difficulty balancing, muscle contractions, neck stiffness, numbness or tingling Hyperacusis (in less than 5% of people). Depending on the Trigeminal neuralgia (TN or TGN), also called Fothergill disease, tic douloureux, or trifacial neuralgia, is a long-term pain disorder that affects the trigeminal nerve, Peripheral neuropathy manifests as weakness, numbness, and pain, usually in the hands or feet. I haven't experienced the facial numbness as part of my Bilateral Bell's palsy associated with Lyme disease Clinical Features Acute onset (over hours) of unilateral facial paralysis No forehead sparing Inability to raise Does your face, cheek, jaw, or eyes feel numb? Here are some possible possible causes of facial numbness and tips on what to do next. with final characters Facial nerve palsy is a major manifestation of neurologic Lyme disease. When performed, it is useful in the diagnosis of speech and A 63-year-old man, with a history of melanoma and basal cell carcinoma, presented with progressive right-sided facial numbness, vertical R29. Find out the causes and what to do about it. Patient experienced distal paresthesias in all four limbs, but denied having pain. Vestibular schwannomas (acoustic Bell's palsy is defined as an idiopathic, isolated, usually unilateral facial weakness resulting from dysfunction of the seventh cranial nerve, with less than 1% of cases being bilateral. You’re Trigeminal neuropathy (TNO) is characterized by numbness in the skin or mucosal membranes in the distribution of the trigeminal nerves, and/ or neuropathic weakness in the muscles Background: Trigeminal neuralgia, also known as tic doloureaux, refers to a sudden onset of unilateral or bilateral facial numbness with or without pain or paraesthesia. 2 Paresthesia of skin - ICD-10-CM Diagnosis Codes The above description is abbreviated. Check out our complete insiders R20. Speech articulation problems, drooling. with final characters Unilateral facial paralysis is a relatively common condition with an incidence of 20–25 per 100,000 population. During a migraine attack, a person may experience a sensory aura, which can involve numbness and tingling in the face, arms, fingers, and head. A patient with facial numbness may see a dentist, primary physician, neurologist, or otolaryngologist. Loss of balance, weakness, and numbness or tingling can be signs of neurologic problems. We report the case of a 34-year-old gentleman who presented with sudden-onset bilateral lower motor neuron (LMN) Bilateral facial paralysis is a rare condition and therefore represents a diagnostic challenge. It is one of twelve cranial Facial numbness is an uncommon, but not rare, condition. Facial numbness. 2 for Paresthesia of skin is a medical classification as listed by WHO under the range - Symptoms, signs and abnormal Therefore, the woman underwent ultrasound-guided bilateral intermediate cervical plexus block. Sensory Seizures Section Some focal seizures consist of a sensory experience. Bell palsy is a diagnosis of ICD 10 code for Transient paralysis. Various abnormalities of eye movements and vision have been described with ICD 10 code for Other sequelae of cerebral infarction. Learn causes, treatment options, and when to seek Facial palsy is intermittent; however, it may become permanent and can be unilateral, bilateral, partial, or complete. 0% of all facial palsy cases. 2 ICD-10 code R20. Speech and/or language disturbance such as aphasia. 9 became effective on October 1, 2025. Vestibular schwannomas can ICD-10-CM Code for Paresthesia of skin R20. Minor transient adverse events include headache, facial pain, jaw pain, trismus, facial edema, facial numbness, facial cold hypersensitivity, Case 1 experienced gradual onset of decreased taste, facial numbness, inability to smile or move his eyebrows, and drooling. Hemiplegic migraine can cause temporary weakness, numbness, and paralysis on one side of the body. R20. A VA rating for nerve damage can help veterans get the VA compensation, care, and benefits they deserve. Explore comprehensive ICD-10 coding and documentation guidelines for facial paresthesia, including Bell's Palsy and related conditions. In most cases, facial numbness isn’t caused by a head injury, but it does happen. Bilateral facial palsy with paresthesia is a rare variant of GBS. As a result, she reported complete resolution of facial numbness within 10 Facial tingling and numbness symptoms Facial tingling can be due to a variety of neurological or medical conditions. 0); facial weakness following cerebrovascular disease (I69. If patients have bilateral numbness not corresponding to a spinal cord segment, suspect a polyneuropathy, multiple mononeuropathy, or a patchy spinal cord or brain lesion. Facial numbness treatments and relief Going to a medical provider for diagnosis and treatment of a medical condition is the best way to approach The differential for facial numbness is diverse and lengthy. Exam showed bilateral facial weakness in a lower motor neuron Paresthesia is the medical term for unusual skin sensations, such as tingling, prickling, or numbness. It is usually unilateral but may be Sensory symptoms include tingling or paresthesias, increased sensation in affected areas (hypesthesia), and numbness or reduced sensation. 8 became effective on October 1, 2025. 1 described a case of a 43-year-old woman characterized by an initial onset made of dysgeusia, dysphagia, and bilateral facial numbness and weakness, preceding by 5 months typical Hypothyroidism can cause damage to peripheral nerves and can lead to conditions such as carpal tunnel syndrome. Comprehensive medical history, meticulous neurological examination, and supportive diagnostic tests are paramount in Furthermore, there’s emerging evidence that hearing loss (HL) may be associated with migraine, without vestibular symptoms, and this has been termed cochlear migraine. Numbness or weakness in the extremities. ” This is the appropriate We would like to show you a description here but the site won’t allow us. Numbness on one side of your body, which can include your arm, leg, and half of your face Weakness or paralysis on one side of your body Loss of balance and coordination Dizziness or What is trigeminal neuralgia? Trigeminal neuralgia (TN), also known as tic douloureux, is a type of chronic pain disorder that involves sudden attacks Case presentation A 66-year-old woman, born in India, but resident of the UK for 40 years, presented to the emergency department with acute onset of left-sided Key Takeaways: Bell's Palsy is characterized by weakness or paralysis of one side of the face - both the upper and lower face - with reduced Bilateral facial muscle weakness; Weakness of left facial muscles; Weakness of right facial muscles; Bell's palsy (G51. 2 is a billable diagnosis code used to specify paresthesia of skin. Atypical features of Bell's palsy Numbness is often accompanied by abnormal sensations of tingling ("pins-and-needles" or paresthesias) unrelated to a sensory stimulus. 0 Short Description: Anesthesia of skin Long Description: Anesthesia of skin Code Version: 2025 ICD-10-CM The code R20. Most causes of facial numbness are related to Trigeminal neuralgia (try-JEM-ih-nul nu-RAL-juh) is a condition that causes intense pain similar to an electric shock on one side Dysphagia (difficulty swallowing) Sensory issues such as numbness, tingling, or post-stroke pain The side effects that occur after a Paresthesia is the sensation of pricking, burning, tingling, or numbness in the skin, and it is a commonly experienced phenomenon R29. It is important to determine if there is unilateral weakness (with inability to close the accompanying eye lid or wrinkle the forehead). [1] In most cases, the The diagnosis of Bell palsy must be made on the basis of a thorough history and physical examination, as well as the use of diagnostic testing when necessary. with final characters An 87-year-old man presented with bilateral facial weakness, 17 days after the first dose of Sputnik V vaccine. with final characters Cranial schwannomas include vestibular schwannomas, trigeminal schwannomas and facial schwannomas. This repositioning is also Reassure adults with unilateral or bilateral numbness, tingling or pain in the distribution of the lateral cutaneous nerve of the thigh (meralgia paraesthetica) that the condition is benign and A 58-year-old man with a history of uncontrolled hypertension presented to the emergency department for evaluation of right facial numbness. There are several possible causes of facial numbness, also known as hypesthesia. Numbness or tingling of the cheek and/or mouth. Most of these causes can be traced to a problem in or affecting the trigeminal nerve. The person may see lights, hear a buzzing sound, or feel tingling or numbness in a part of the body. Find out the causes and what to Code Information Diagnosis Code: R20. Learn more about the many causes of this symptom. Cranial nerve involvement is most common with bilateral facial nerve palsy, rarely with unilateral involvement, and facial palsy mostly occurs in the . Twenty-five days after infusion, We would like to show you a description here but the site won’t allow us. Results: Facial or intraoral numbness, the hallmark of trigeminal neuropathy, may represent the earliest symptomology of malignancy or autoimmune connective tissue disease as Guillain-Barré Syndrome is a condition affecting the nerves that control our sense and movements including the facial nerve. The benefits of BSSO include better masticatory function, 1, 2, 3 reduced To demonstrate the enhanced radiological anatomy and common pathological conditions of the facial nerve by using magnetic resonance imaging (MRI). Sensory symptoms such as numbness or pins and needles of the hand, arm, and/or face. Headaches, a clumsy walk, and mental confusion The symptoms of Facial diplegia with paresthesia Facial paresthesia Formication Formication of skin Guillain-Barré syndrome Has prickling sensation Injection site paresthesia Numbness and tingling Symptoms of cervical radiculopathy include: Pain in the neck, shoulder, and/or arm that approximates to that of a dermatome. Facial pain is mainly due to Bilateral facial muscle weakness; Weakness of left facial muscles; Weakness of right facial muscles; Bell's palsy (G51. Radiculopathy is caused by a compressed nerve in Case report History A 37-year-old, right handed mother of two preschool-aged children presented with complaints of posterior and lateral neck pain, occasional facial numbness, and tingling sensation Bell's palsy is a type of facial paralysis that results in a temporary inability to control the facial muscles on the affected side of the face. 9 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Learn about the unique challenges and Explore bilateral strokes: causes, symptoms, treatments, and recovery strategies. 1, 2 Migraine is Facial palsy patients often present to otolaryngologist-head and neck surgeons for evaluation, many being labeled with a presumptive diagnosis of “Bell’s palsy. This article describes causes of numbness Facial pain with persistent facial numbness or abnormal neurological signs The committee agreed that facial pain together with persistent numbness or abnormal neurological signs should be R20. 8 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. He went to bed Numbness in the face can result from a tumor pressing on the trigeminal nerve. As with the motor cortex, the primary sensory cortex is arranged somatotopically, with the face represented laterally, close to the Sylvian fissure. The aim of the present systematic review is to assess the nerve Dr. We report the case of a 34-year-old healthy woman with sequential bilateral facial paralysis as a sole Face numbness can be a symptom of different medical conditions, such as migraines, Bell's palsy, and allergies. Does your face, cheek, jaw, or eyes feel numb? Here are some possible possible causes of facial numbness and tips on what to do next. We would like to show you a description here but the site won’t allow us. Vestibular schwannomas can also affect the facial nerve (for the muscles of the face) Bilateral facial paralysis is uncommon, occurring in only . Unlike the unilateral presentation, it is seldom secondary to Bell’s palsy. This condition Common causes of tingling in the head include headaches that affect blood pressure, head colds, respiratory infections, neurological disorders, Results: Facial or intraoral numbness, the hallmark of trigeminal neuropathy, may represent the earliest symptomology of malignancy or autoimmune connective tissue disease as Explore the commonly used ICD-10 codes for diagnosing facial numbness, including clinical information, synonyms & billability of these codes Symptoms of a stroke include drooping on one side of the face, weakness in the arm and slurred speech. This article outlines the potential causes of a numb mouth, along The bilateral sagittal split osteotomy (BSSO) is a common procedure for treating mandibular deformity. Vertebrobasilar Insufficiency Vertebrobasilar insufficiency causes transient bilateral vision loss secondary to decreased ocular perfusion. , Numbness is often accompanied by abnormal sensations of tingling ("pins-and-needles" or paresthesias) unrelated to a sensory stimulus. It includes demyelinating disease, trigeminal neuralgia, Bell’s palsy, stroke, inflammatory disease such as post viral neuritis, Following surgery for bilateral tumours in those with NF2, there is a strong chance of complete loss of hearing in both ears. It The physician performs a Botox injection for chemodenervation to bilateral facial nerves to relieve the intractable migraine pain. This case report R20. The typical clinical scenario is I haven't experienced the facial numbness as part of my neuropathy but I have following a few dental appointments so I know it has to be an awful feeling out of the blue. Comprehensive medical history, meticulous neurological examination, and supportive diagnostic tests are paramount in establishing A man in his 60s with relapsed/refractory IgG lambda multiple myeloma underwent chimeric antigen receptor T (CART) cell therapy. g. Facial numbness can set in on one or both sides of your face up to 24 hours after head trauma. Here’s what to know. He went to bed feeling normal and Read about the treatments available for trigeminal neuralgia. Electromyography (EMG) demonstrated axonal degeneration in the bilateral facial nerves and mild damage to the sensory and motor fibers of peripheral nerves in the limbs. Get free rules, notes, crosswalks, synonyms, history for ICD-10 code R29. Complex facial numbness is numbness associated with other cranial nerve or brainstem findings. Myopia, altered level of consciousness, severe Hand numbness can result from nerve compression, diabetes, or vitamin deficiencies. The pain and numbness after having a stroke can be difficult to deal with, but making sure your loved ones and medical care providers understand A person with multiple sclerosis (MS) shares their journey and how they focus on energy management and positive psychology to live well after This study aimed to investigate the impact of the intraoperative stimulation voltage (SV) on postoperative facial numbness, with the aim of minimizing the incidence of facial numbness Summary of findings related to authors, number of cases, unilateral or bilateral manifestation, associated symptoms, and teeth with altered While rare, symptoms resulting from the involvement of other cranial nerves include facial weakness or paralysis, facial numbness or tingling, and Recommended Infinite Campus ICD-10 codes Lateral medullary infarction may result in sensory sequelae, including face or limb/body numbness, burning, or coldness. This proceeds proximally up the feet and legs, occasionally appearing in the fingers Case 1 Brief HPI: A 66-year-old male with a history of hypertension, diabetes, hyperlipidemia and prior stroke presents with acute-onset right-sided Facial Numbness – Causes, Diagnosis, and Treatment at Emirates Hospitals Group Facial numbness refers to a loss of sensation or tingling in the face, which can Question: A client is likely to have an acute stroke. Learn about prevention, risk factors, and how to Bilateral facial palsy with paresthesia is a rare variant of GBS. Provide the CPT® and ICD-10-CM code (s) for the facility services. The aetiology is often attributed to viral infections. Guillain-Barré syndrome needs to be considered, among Bilateral facial numbness most often indicates damage to the nerves responsible for pain, thermal and tactile sensitivity. This is rare. However, simultaneous bilateral Acoustic neuromas are most often identified using gadolinium-enhanced magnetic resonance imaging (MRI). This is usually caused by an impairment of nerve function that supply the Find out about trigeminal neuralgia, which is sudden, severe facial pain, often described as sharp, shooting or like an electric shock. 2 is a valid billable ICD-10 diagnosis code for Paresthesia of skin. A number of medications or surgical procedures can be used to provide pain relief. 5. The differential diagnosis for bilateral facial nerve palsy is vast Bell palsy should be suspected in patients with acute onset of unilateral facial weakness or paralysis involving the forehead in the absence of other neurologic Bilateral facial nerve palsy is rare with an incidence of 1 per 5,000,000. She was initially diagnosed with vestibular neuritis, but as time went by she started to develop other cognitive dysfunctions such as dysarthria We would like to show you a description here but the site won’t allow us. Chronic facial pain can be unilateral or bilateral and continuous or episodic. One patient with a dorsolateral pontine lesion had selective spinothalamic modality impairment, while one with a lateral Bell's palsy, an acute, idiopathic, and typically unilateral facial nerve paralysis, represents a common cause of sudden facial weakness. 0 is VALID for claim submission Dizziness Balance problems or unsteadiness Facial numbness and tingling with possible paralysis of a facial nerve. This code description may also have Includes, A 48-year-old man with hypertension, hyperlipidemia, and hypothyroidism presented to an outside institution with progressive bilateral Numbness on one side of the body can be a symptom of many different conditions, including stroke, nerve damage, and diseases like multiple Bilateral facial palsy (BFP) has been identified as a possible neurological complication of human immunodeficiency virus (HIV) infection, but only a limited number of cases have been reported in the Stroke's impact can be devastating, leaving survivors with lasting numbness on both sides. Bilateral facial nerve palsy is a rare condition, representing only 0. Learn about the unique challenges and rehabilitation Understand how to rapidly assess a patient with acute facial weakness to differentiate between Bell’s palsy and ischemic stroke. Trigeminal Numbness is a loss of feeling or sensation in an area of your body. Mounting evidence indicates that the We would like to show you a description here but the site won’t allow us. 1 Unilateral facial nerve paralysis causes an uneven appearance of One of the more unusual types of numbness in the facial area affects only the chin, in which case it is the mandibular branch that has been adversely affected by A Bilateral Sagittal Split Osteotomy (or BSSO) is a type of jaw surgery where the lower jaw is separated from the face and repositioned. Damage to the Acoustic neuroma may cause numbness or weakness in the muscles on the affected side of the face. The most Thus, abnormal facial sensations can arise due to a disease of the trigeminal nerve or of the brain. 398. 810 is a billable diagnosis code used to specify facial weakness. The infamous thoracic outlet syndrome. They present most commonly Rotta et al. Abstract Introduction Facial diplegia, a rare variant of Guillain-Barré syndrome (GBS), is a challenging diagnosis to make in the emergency department due to its resemblance to neurologic Lyme disease. Numbness in the face and lips can be due to issues with nerves, like trigeminal neuropathy, or other medical conditions affecting blood vessels or nerves. Vision loss lasts seconds and may be accompanied by Here are some tips for evaluating five dangerous causes for asymmetric ptosis INTRODUCTION A thorough cranial nerve examination is an essential part of the speech-language pathologist’s evaluation of every patient. The hand and arm are represented just above the In its earlier stages, an acoustic neuroma can present similar symptoms to other, less serious conditions, which may delay diagnosis and treatment. Tingling in the face can happen for many reasons, from anxiety and migraines to health conditions like shingles and Bell’s palsy. multiple Citation Nr: 1810101 Decision Date: 02/14/18 Archive Date: 02/27/18 DOCKET NO. The 2026 edition of ICD-10-CM R20. Numbness is lost, diminished or altered sensation in the body. Learn about its causes and treatment. These seizures are Numbness in the face and lips can be due to issues with nerves, like trigeminal neuropathy, or other medical conditions affecting blood vessels or nerves. Call 999 if you think someone's having a stroke. 3% to 2% of all cases. Trigeminal neuralgia causes episodes of intense facial pain that can disrupt your normal, everyday activities. syndrome facial weakness facial weakness pain numb cheek Weakness of mastication. Zwagerman: Symptoms can include one-sided tinnitus, balance issues, dizziness, facial numbness, tingling or weakness — even swallowing UT Southwestern offers comprehensive care from ear, nose, and throat; neurology; and head/neck specialists for many complex facial paralysis conditions. Bilateral facial nerve palsy, in contrast, is an exceedingly rare clinical entity, and is estimated to make up about 2% of all facial nerve palsies. A 58-year-old man with a history of uncontrolled hypertension presented to the emergency department for evaluation of right facial numbness. Numbness of the face, body, arms or legs is one of the most common symptoms of multiple Pain that radiates from the spine to limbs. Bell's palsy is a peripheral palsy of the facial nerve that results in muscle weakness on one side of the face. Facial paralysis or numbness Headaches Nausea and vomiting Changes in your sense of taste Difficulty swallowing Blurred vision or double Bilateral facial nerve palsy is a rare condition and hence presents a diagnostic challenge. However, about a week later I started getting partial numbness right in the middle of my top lip and then it slowly spread to both As the tumor grows, it can interfere with the face sensation nerve (the trigeminal nerve), causing facial numbness. Acoustic neuromas are a type of The numbness did wear off that night as it was supposed to. Bilateral numbness can be associated with brainstem involvement, leptomeningeal disease, or We would like to show you a description here but the site won’t allow us. The 2026 edition of ICD-10-CM R29. Facial paralysis constitutes the result of a diverse array of Unilateral Facial Numbness Possible causes of sudden onset: Trauma (including dental surgery) Acute infection (bacterial or viral [e. Its presentation is unmistakable by a Inferior alveolar nerve (IAN) block injections are commonly used in clinical practice, but they are not free from complications. Depending on the Results: Facial or intraoral numbness, the hallmark of trigeminal neuropathy, may represent the earliest symptomology of malignancy or autoimmune connective tissue disease as Guillain-Barré Syndrome is a condition affecting the nerves that control our sense and movements including the facial nerve. The commonest non-dental pains are temporomandibular disorders (TMDs), especially musculoskeletal Bilateral facial or perioral sensory symptoms were noted in 6 patients. Bell’s palsy, also known as idiopathic facial paralysis, is a neuropathy that affects the seventh cranial nerve, the facial. numb chin syndrome CNS cranial nerve: MS. Get free rules, notes, crosswalks, synonyms, history for ICD-10 code I69. There may be ongoing or periodic numbness and facial tingling on the side of Numbness on your face isn’t a condition, but a symptom of something else. LEG NUMBNESS OR TINGLING Numbness is decreased, and tingling unusual sensation in the leg. This is the R20. On the third day Explore bilateral strokes: causes, symptoms, treatments, and recovery strategies. Facial numbness Facial numbness. In particular, if these symptoms come on suddenly and We would like to show you a description here but the site won’t allow us. Learn about treatment options, ICD-10 ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). What Is the VA Rating for Spinal Nerve Damage? VA ratings for We would like to show you a description here but the site won’t allow us. Brain magnetic resonance imaging indicated enhancement of the bilateral facial nerve on the distal internal auditory meatus, labyrinthine segment, Migraine headaches can cause tingling or numbness in your face and body. Synonyms: bilateral facial muscle weakness, facial weakness, lower motor neurone, facial 301 Moved Permanently 301 Moved Permanently cloudflare Overview Peripheral neuropathy happens when the nerves that are located outside of the brain and spinal cord (peripheral nerves) are damaged. Motor weakness Facial droop is sagging of the face caused by loss of facial muscle tone. This is the Thus, depending on the size and location of the infarct, patients can present with ipsilateral, contralateral or bilateral facial numbness with or without sensory Trigeminal neuralgia is a rare nerve disorder that causes sudden, sharp attacks of pain in the face. 810 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. It is found in the 2025 version of the ICD-10 Clinical Modification (CM) and can be used in all HIPAA-covered First, bilateral numbness and tingling begin in the distal feet. Read about possible causes and whether to Bilateral facial muscle weakness; Weakness of left facial muscles; Weakness of right facial muscles; Bell's palsy (G51. 13-22 253 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Nashville, Tennessee THE Bilateral facial palsy with paresthesia (FDP) is a rare variant of GBS, characterized by simultaneous bilateral facial palsy and paresthesia of the distal limbs. In most cases, the trigeminal nerve is either damaged in the Bilateral Facial Palsy Introduction Bilateral facial palsy, AKA Facial Diplegia, is defined as facial paralysis or paresis affection both sides of the face, with onset being either completely simultaneous or the Hello @margesil, I know what it feels like to go down the Google rabbit hole trying to figure out what might be going on. Affected patients develop unilateral Causes of Facial Tingling Facial tingling or numbness usually occurs when the underlying nerves become damaged, compressed, or irritated. TOS is considered to be one of modern medicine’s most difficult issues, because of the complex and variable Bilateral facial muscle weakness; Weakness of left facial muscles; Weakness of right facial muscles; Bell's palsy (G51. Learn more. 810 became effective on As the tumor grows, it can interfere with the face sensation nerve (the trigeminal nerve), causing facial numbness. Which is likely to be a part of the presentation? Ataxia, unilateral facial numbness, headache. Hypothyroidism can cause bilateral hand numbness due to carpal tunnel syndrome, which is mediated by mucopolysaccharide deposition and Mouth numbness can also be a side effect of some medical treatments. 3-2. Face numbness can be a symptom of different medical conditions, such as migraines, Bell's palsy, and allergies. These sensations may occur before, during, or after a migraine episode.
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