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“how-to” guide to help providers successfully prescribe oxygen for cluster headaches

by | Jul 23, 2020 | Busters Blog

Clusterbusters, Inc. has purchased the rights to distribute an article that serves as a “how-to” guide to help providers successfully prescribe oxygen for cluster headaches. It’s a well-known fact that patients with episodic and chronic cluster headaches have a tremendously difficult time getting a prescription for high-flow oxygen therapy to treat acute attacks. We also face barriers in getting the correct flow rate, mask, and insurance coverage.

Dr. Stewart Tepper, a Neurologist at Dartmouth-Hitchcock Neurology Center, wrote this three-page article in 2017 to help providers in any healthcare setting, understand the difficulties facing cluster headache patients and oxygen therapy. This article is available in multiple places on www.clusterbusters.org, including here and linked below and linked at the bottom of this page. We recommend you print this and bring it with you to your next appointment. Any medical professional can prescribe home oxygen for cluster headaches using this guide, be it your primary care physician, internist, or OBGYN.  

Oxygen therapy for cluster headaches is the standard of care for stopping individual attacks. This treatment is listed as “Level A” or “first-line” by headache organizations and entities worldwide, including the American Headache Society and International Headache Society. Despite evidence from randomized controlled trials, the Centers for Medicaid and Medicare Services (CMS) continue to deny coverage for home oxygen for cluster headache.

While Clusterbusters and U.S. headache specialists will keep fighting this egregious decision by CMS, those who have commercial insurance are still able to get oxygen therapy covered for the condition, which is made easier using the Tepper 2017 “how-to” document. Cluster patients who have Medicaid or Medicare will have to pay out of pocket, which can be less than $1,000 per year for episodics but could exceed $5,000 a year for chronics, creating an economic burden for cluster patients. For that reason, many people resort to using welding oxygen.

Prescribing Home Oxygen for Cluster Headaches per Tepper’s “How-To” Guide
According to the document, providers must order high-flow oxygen as “medication,” “home oxygen,” or “durable medical equipment prescription” in the Electronic Medical Record (EMR). It’s essential to note the tank size as oxygen suppliers across the United States have different lettering systems for their tanks. Prescribing doctors, nurse practitioners, or physician’s assistants should include “large tank” on the prescription order and one or more small tanks portable for travel.

Tepper, et al. recommend the prescription for oxygen for cluster headaches read: 

“Home Oxygen for Cluster Headache

Sig and Rate: Sit up and lean forward and breathe deeply 10-15 L/minute for up to 20 minutes per attack.

Route: Non-rebreather face mask, please include full mask and tubing.

Hours per day of usage: PRN to be determined by number of attacks per day

Number of months service needed: 12″

In addition, Dr. Tepper recommends providers include the following comment in the EMR: This patient with cluster headache needs a large tank for home and a portable tank for work and leaving the house. The oxygen therapy is medically necessary to abort cluster headache attacks and improve functioning. Each treatment is to give 10-15 L/minute for 1-2 hours (usual duration 20 minutes). Please give patient tubing and a full re-breather mask.

Your provider needs to print the prescription and either give it to you (the patient) or fax it to a local oxygen supplier. Even with this detailed script, your commercial insurance may try to deny coverage and request more information such as a CPT (Current Procedural Terminology) code, which are E0424, E0441, or E0443 for oxygen systems for cluster headache. The US ICD-10 diagnostic codes for cluster headaches may also be needed, which include:

  • G44.009 Cluster Headache
  • G44.019 Episodic Cluster Headache
  • G44.029 Chronic Cluster Headache
  • G44.011 Intractable Episodic Cluster Headache
  • G44.021 Intractable Chronic Cluster Headache
  • G44.001 Intractable Cluster Headache with unspecified chronicity pattern

Providers Have a “Clinical Obligation” to Prescribe Oxygen to Cluster Headache Patients

Most neurologists and headache specialists in the United States provide a prescription for home oxygen to treat cluster headache attacks immediately after making the diagnosis. However, with just 1.2 certified headache specialists per 100,000 patients, other healthcare providers must pick up the slack and provide the prescription to cluster headache patients, so they can access the number one treatment for the condition that is both safe and effective. High-flow oxygen is considered “Level A” treatment by the American Headache Society and first-line medication for cluster headaches worldwide.

This document has already been immensely helpful for patients to get oxygen therapy for cluster headaches. Clusterbusters, Inc. purchased the right to distribute the article so that every patient struggling to get oxygen can share this valuable information with their doctor or prescribing medical professional. Tepper’s article also greatly increases your chances of getting your commercial insurance provider (such as Cigna®, who lists it on their website) to cover the cost of home oxygen.

Using this “how-to” guide for prescribing oxygen, providers can reduce the physical and economic burden of cluster headaches on patients and improve quality of life. 


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