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        Cluster Headache Help and Support >> Medications, Treatments, Therapies >> oxygen prescription
        
(Message started by: slacker032 on Nov 1^st, 2007, 2:41am)

Title: oxygen prescription
Post by slacker032 on Nov 1^st, 2007, 2:41am

Going to see a neuro tomorrow to ask for a O2 prescription. Does he need to fill out a Certificate of Medical Necessity (CMS-484) or will a simple prescription suffice? Also, is there any specific document I should bring to convince him that this is the treatment I need?

Title: Re: oxygen prescription
Post by Bob_Johnson on Nov 1^st, 2007, 7:12am

Print this for your doc. He will recognize the source as authority.
---------------
Headache. 2005 Jan;45(1):98. Related Articles, Links

CLUSTER.

[No authors listed]

Rozen TD. High oxygen-flow rates for cluster headache. Neurology. 2004;63:593 The two most effective cluster abortive agents are injectable sumatriptan and inhaled oxygen. Because most cluster headache sufferers are cigarette smokers and at high risk of coronary artery disease, many develop contraindications to triptans. Oxygen, the safest of all cluster therapies, is not effective for every patient. In Kudrow's landmark study, 75% of patients responded to 100% oxygen at 7 L/min, although only 57% of older chronic cluster headache patients had relief. A recent study documented a gender difference in response to oxygen because only 59% of female cluster patients responded to oxygen, whereas 87% of men did. In most textbooks and articles on cluster headache treatment, patients are instructed to use 100% oxygen via a nonrebreather face mask at 7 to 10 L/min. The rationale behind this prescribed oxygen-flow rate is unknown but has become doctrine since the Kudrow study. Prescribing higher flow rates of oxygen up to 12 L/min has recently been suggested, but there is no documentation that this may improve efficacy. Higher oxygen-flow rates (up to 15 L/min) are not known to benefit cluster headache patients refractory to standard oxygen therapy. Three cluster headache patients who demonstrated no response to standard oxygen therapy were exposed to higher flow rates of oxygen (14 to 15 L/min) to assess response. Comments: Once again, Dr. Todd Rozen's observations will change my clinical practice!-Stewart J. Tepper, MD I have questions: Were these empirical observations or do Drs. Kudrow and Rozen know how rate of flow affects oxygen delivery? Is oxygen uptake higher with higher flows? After all, 100% oxygen is 100% oxygen unless under hyperbaric pressure! Perhaps higher flow rates dry the nasopharyx to a greater extent. If patients perceive a higher flow rate, might this be an enhanced placebo effect? It seems like an interesting study to be conducted, and it would be useful to test if using nasal cannulae is just as good. Pulse oximetry and arterialized capillary blood gases could be used to monitor oxygen saturation and CO(2) retention/carboxyhaemoglobin levels in smokers.-David S. Millson, MD.

PMID: 15663630 [PubMed - as supplied by publisher]

Title: Re: oxygen prescription
Post by DennisM1045 on Nov 1^st, 2007, 8:23am

It all depends on the Insurance company. Some will accept a perscription and other will require the letter. Blue Cross and CIGNA both accepted the perscription. Though it wasn't clear within CIGNA at the beginning and I had a letter ready to go if needed. It can't hurt to ask and have it in hand. Good luck...

-Dennis-