Monthly Archives: April 2006

72 – Headaches

Bad headaches can be extremely debilitating. Here I tell how I got mine under control, after years of pretty serious suffering.

I am very susceptible to headaches. Mostly they just slow me down, but sometimes they bring me to a complete stop and send me to bed. Those are migraines, sometimes complete with nausea, light sensitivity and visual distortions, and usually lasting 16 to 24 hours. There is something especially awful about going to bed with an agonising migraine, and waking up the next day with it still going full bore.

Headaches have always been a problem for me, but in 2004 they reached new depths; in August of that year I was getting 2 or 3 migraines per week. Apart from the pain, it was getting disruptive to life and work.

Pauline got rightly frustrated with my failure to do something decisive about my headaches, and bought me some books about them. After I’d read them, I felt that one of them really stood out as seeming authoritative and practical. It was Heal Your Headache by David Buchholz, a headache specialist in the Neurology Clinic at Johns Hopkins University School of Medicine. Starting in September 2004, I followed his advice, and since then my frequency of headaches has fallen by a factor of around 20. To thank him, this is an unashamed plug for his book. If you know anyone who suffers from regular headaches, buy them Heal Your Headache.

Buchholz’s advice is firmly grounded in practical experience with thousands of headache patients, many of them patients who had previously been failed by the medical system.

He believes that almost all headaches have the same basic causes. In other words, most headaches are migraines, but their severity varies enormously. There are many potential triggers for headaches, some unavoidable or difficult to avoid (e.g. changes in barometric pressure, menopause, stress) and some much easier to avoid (e.g. dehydration, a range of dietary triggers). If your total load of triggers goes above your personal threshold, you get a headache.

Buchholz focuses a lot on dietary triggers as being the thing that is easiest for most people to manage. He provides a long list of foods and drinks that are migraine triggers for significant numbers of people. The list includes: caffeine, alcohol, MSG, chocolate, salami, aged cheeses, nuts, citrus fruits, bananas, lentils, and dried fruits. Initially I went off everything on the list, but I’ve gradually loosened up a bit and now allow myself small amounts of most things on the list. The only things I totally exclude are caffeine, red wine and MSG, which I think are probably my main triggers. It is hard to tell for certain, though, because it is possible to consume some of a trigger without getting a headache, as long as your total consumption of triggers doesn’t take you above your personal threshold. Conveniently, some foods on the list are things I hate, like faba beans and chicken livers.

The thing that was by far the hardest to go without was red wine. Apart from that, is was really quite easy to change my diet. And, given the benefits of abstinence, even red wine is worth foregoing.

There is a lot more useful stuff in the book (e.g. about medicines), but it was the dietary stuff that really worked for me.

If you know a serious headache sufferer, they need this book.

David Pannell, The University of Western Australia

Further Reading

Buchholz, D. (2002). Heal Your Headache: The 1-2-3 Program for Taking Charge of Your Pain, Workman, New York.

“Heady Reading”, a discussion of the above book.

Buy the book from Amazon. And if you don’t believe me read the customer reviews there. All 5-star glowing tributes.

71 – Thinking like an economist 23: Agonising decisions

Decisions with important consequences can sometimes be ‘agonising’. We can go round and round in our minds, struggling to choose between two finely balanced options. Fear of making the wrong choice stops us from settling on a decision. Decision analysis provides an insight that can help us to break out of this painful cycle of indecision.

The real estate investment I discussed in PD#70 is a good example of an agonising decision. I could invest in a house, but face the risk that the market would subsequently fall, or I could invest in something other than a house and face the risk that the housing market would subsequently rise. Owning a house in Perth could be convenient to us as a family in the future, but finding and dealing with tenants would be inconvenient in the short term. Overall, the best choice was not at all obvious. I took longer than I should have to make a decision to buy, and, in retrospect, lost a substantial amount because the market rose while I dithered.

But that is all very well ‘in retrospect’. If I’d known that in advance, the decision wouldn’t have been agonising. The essence of an agonising decision is that, in prospect, the options appear finely balanced and difficult to separate.

‘Decision analysis’ can help you break out of this impasse, although perhaps not quite in the way you might expect.

Decision analysis is a formal approach in which you systematically weigh up your decision options, their possible consequences, the probabilities of those consequences, and how important the consequences are to you (Anderson et al., 1977). The suggested criterion for choice is the option that maximises the expected value of your objective, where I mean ‘expected’ in the statistical sense of a weighted average.

I remember reading about one of the leading figures in decision analysis who was agonising over a big decision affecting his personal life. One of his students asked him, ‘Why don’t you use decision analysis to help you?’ His response was something like, ‘Don’t be silly! This is far too important for that.’

This says something about the importance of emotion and intuition in decision making, but I don’t think decision analysis is as unhelpful as that, even for the most emotion-charged decisions. The reason is that it provides a powerful, though simple, insight that I, at least, find very helpful.

The insight is that it doesn’t matter. If you weigh up your decision options, their possible consequences, the probabilities, and so on, and find that in your personal circumstances and given your personal perceptions and preferences, the options are finely balanced, then it doesn’t matter which you choose.

In future, when you look back at the decision and consider it in retrospect, your current choice will matter, but in prospect, the options are finely balanced, so either will give almost the same expected payoff.

So don’t agonise. If you can’t collect additional information to help break the deadlock, then use any criterion you like to select a decision option. Toss a coin. Choose the most adventurous option. Choose the one your partner would prefer. Anything at all. Just choose one, without agonising. Agonising cannot improve your decision, because, whether you swap from option A to B or back again, the expected gain or loss is minimal. And in the short term, agonising is painful, so don’t suffer needlessly.

David Pannell, The University of Western Australia

Further Reading

Anderson, J.R., Dillon, J.L. and Hardaker, J.B. (1977). Agricultural Decision Analysis. Ames: Iowa State University Press.