The Veterans Administration referred an Iraq War Veteran for acupuncture to reduce his severe headaches caused by high cerebrospinal fluid pressure. Unfortunately they only approved 3 visits. This is the letter I sent to the VA asking for approval for more treatments.

January 23, 2008

Dear Ms. XXXXXX:

I’m writing to request authorization for more acupuncture treatments for Mr. XXXX. I have seen him 3 times (treatment notes attached), and believe that acupuncture could be beneficial in reducing or eliminating his headaches if it were administered with the appropriate frequency and for an appropriate duration of time. In my experience (and training) 3 visits is inadequate to deal with most problems, even more superficial ones than the severe headaches plaguing Mr. XXXX.

As you know, Mr. XXXX presents with an 8 year history of daily constant headaches that become so excruciating that he must pack his head in ice and stay in bed for days. Such peak-pain events usually occur on a weekly basis. He also has a history of Irritable Bowel Syndrome (IBS) and depression. Because his headaches are so severe, the problem is so long-standing, and there are other systemic problems (IBS and depression) appropriate acupuncture treatments would be 2 x week for an indefinite duration, but lasting for at least 2 months.

I treated him 3 times, and was able to see the differences in his pulse (and in other diagnostic parameters of acupuncture) before, during and after an episode of peak pain. This gave me invaluable diagnostic information to inform my treatment plan, but was inadequate to effect lasting change. The diagnostic information gleaned from his recent treatments could be summarized as follows:

The shifts in his pulse indicate an alternating pattern of deficiency and excess (these are technical terms of Traditional Chinese Medicine), which is not uncommon in individuals with a history of trauma. I’ve treated many people with this sort of presentation. They have had a variety of presenting complaints (most often idiopathic), but they have been identical in this underlying bi-phasic pattern of disregulation.

It is as if some part of the person’s systemic processes is so up-regulated that the resulting over-drive leads to cyclic collapse. In Mr. XXXX’s case, the over-drive is causing increased intracranial hypertension, resulting in the daily headaches. The collapse occurs when the headache crescendos into pain so severe it requires drastic measures (ice, bed-rest, and in some cases drainage of the cerebrospinal fluid), and results in a drastic reduction in available resources. This reduced state of functioning temporarily short-circuits the building pressure. His pulse is strong and bounding during “daily headache” phases (as are other diagnostic parameters), and stronger still immediately preceding a peak-pain event. The over-drive cannot be sustained, however. During the peak-pain event, and as it begins to subside, all diagnostic parameters (pulse included) indicate a severely deficient, exhausted, weak condition.

According to Mr. XXXX, one of his doctors at Togus drained off some cerebrospinal fluid (CSF) on several occasions, but informed him after the 3rd time that it was not a sustainable treatment modality because each time the fluid was drained, Mr. XXXX’s body reacted in increased over-drive, creating even more CSF pressure, and more pain. The fact that the drainage of the CSF led to a few short days of relief but was followed by even higher pressure levels is consistent with this analysis of a complex condition that alternates between excess and deficient states. I believe that acupuncture can provide the “drainage” (energetically, not literally) without the subsequent increase in pressure which occurred after the three spinal taps.

The CSF drainage failed because it did nothing to reset the faulty regulation system. From the perspective of Chinese Medicine, Mr. XXXX’s peak-pain events are his body’s desperate attempt to down-regulate his chronically up-regulated system. The normal headache is a result of the up-regulation that has become his norm. Each peak-pain event is his own answer to a faulty regulation system, an answer that accomplishes the necessary down-regulation, but only temporarily and at too great a cost. The CSF drainage acted in a manner that was similar to the body’s own peak-pain event; the relief was temporary and the cost –even higher CSF pressure–too great.

The goal of any acupuncture treatment is to reset whatever regulatory or systemic processes that are out of balance. In cases such as this, with an alternating dys-regulation, two treatment strategies are required. To put it in lay terms, one must down-drive the excess without triggering a collapse, and supplement after a collapse without triggering an over-drive. The result of regular acupuncture that addresses these issues will be a gradual reduction in severity of the headaches, a decrease in the frequency and duration of peak-pain events, and ultimately an eradication of peak-pain events. The last to decrease and hopefully disappear with such a treatment plan would be the daily headache.

Acupuncture is based on such a different way of thinking, that it can be difficult to translate its medical paradigm for a western audience. As a westerner, it’s important to me to try. I’d be very happy to engage in further discussion with you. Please let me know if you have any questions. I look forward to scheduling Mr. XXXX for more acupuncture treatments.

Thank you.

Yours truly,

Julie Meyer, M.Ac.
Licensed Acupuncturist

cc: Mr. XXXX