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14 It recommends rapid initiation of alternate-day intramuscular hydroxocobalamin therapy, and maintenance of this treatment until all symptoms have resolved or there is no further neurological improvement, with long term B 12 therapy depending on the presence of deficiency on presentation, together with total abstinence from the use of nitrous oxide

Can be provoked by light touch to the face, eating, cold winds, or vibrations Rarely associated with history of other chronic pain or migraine

They also carry the risks inherent to any surgical procedure, require recovery time, and demand lifelong nutritional follow-up

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If the documentation doesnt state no crisis, the payer may assume a crisis could be present