Oxygen Survey

Please take a moment to complete this survey about your experience with using Oxygen as an abortive for cluster headaches.

The results of this survey will be shared with medical professionals to help them prescribe the correct treatment for their cluster patients.

If you don't see some of your answers on the "Results" page, don't worry, you completed the survey correctly. Some answers cannot be shown because of the way the program operates. Your responses were received and will be used when we analyze the results.
1. What is your sex? female
male
2. What year were you born? year of birth
3. Are your clusters episodic or chronic? episodic
chronic
4. Did you experience any difficulty getting your Doctor to prescribe O2? yes
no
5. Does your health insurance cover Oxygen? yes
no
don't have insurance
6. Did you experience any difficulty getting your insurance to cover the O2 for treating your clusters? yes
no
don't have insurance
7. What flow rate of Oxygen did you use?

 

5 lpm (liters per minute) or less
 6-8 lpm
 9-11 lpm
 12 lpm or higher
not sure
8. What type of delivery system did you use?

 

canula
 mask - regular
 mask - nonrebreather
 other (I just sucked on the hose)
9. At what stage of the headache's development did you start breathing the Oxygen? at the first sign
during the first 5 minutes
6-10 minutes after start of headache
11-15 minutes after start of headache
more than 15 minutes after start of headache
10. Were you taking any preventative medications such as lithium, topamax, prednisone, verapamil, etc. at the same time that you were using Oxygen? yes
name of medication
no
11. Were you taking any other abortive medications at the same time that you were using Oxygen? yes

name of medication
no
12. Did the Oxygen abort your headache?

 

Yes
 No (skip to question #14)
13. If it aborted your headache, how long did it normally take to become effective?

 

5 minutes or less
 6-10 minutes
 11-15 minutes
 16-20 minutes
21-25 minutes
26-30 minutes
 31 minutes or more
NA
You are done! Go to the bottom of the survey, enter optional information and submit.
14. Did it reduce the intensity of your headache? yes
no (skip to "Optional Information" at the bottom of the form)
NA
15.  How much did it reduce the intensity of your headache? 25% or less
25-50%
50-75%
75-99%
NA
Optional Information
E-mail Address
Comments: