High altitude headache

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Adela Brooks
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1 High altitude headache

High altitude sickness or acute mountain sickness are common names for illnesses that can occur at high altitude, usually over 3000 meters above sea level.

Headache is the most common neurological symptom and complication, arising from ascent to altitudes greater than 2500 to 3000 metres but loss of appetite, nausea and sleep disturbances are also

2 High altitude sickness or acute mountain sickness are common names for illnesses that can occur at high altitude, usually over 3000 meters above sea level. The cause is hypoxia which is a deficiency in the amount of oxygen reaching body tissues. However, the underlying physiological process is a complex mixture of factors. Headache is the most common neurological symptom and complication, arising from ascent to altitudes greater than 2500 to 3000 metres but loss of appetite, nausea and sleep disturbances are also common complaints. High altitude sickness can be prevented by slow ascent and avoiding overexertion. Many trekkers or climbers develop two or three symptoms of high altitude illness after rapid ascent (over 300 metres per day) to an altitude above 3000 to 4000 metres. Heavy perceived exertion, a history of migraine, the absolute altitude reached, little mountaineering experience and inadequate water intake (less than two litres) have been found to be independent risk factors for acute mountain sickness.

The International Headache Society (IHS) defines High Altitude Headache (HAH) as: A. Headache with at least two of the following characteristics and fulfilling criteria C and D 1. Bilateral 2.

3 The International Headache Society (IHS) defines High Altitude Headache (HAH) as: A. Headache with at least two of the following characteristics and fulfilling criteria C and D 1. Bilateral 2. Frontal or frontotemporal (at the front of the head in the region of the temples) 3. Dull or pressing quality 4. Mild or moderate intensity 5. Aggravated by exertion, movement, straining, coughing or bending B. Ascent to altitude above 2500 metres C. Headache develops within 24 hours after ascent D. Headache resolves within eight hours of descent

Research A study analysed the incidence, risk factors and clinical characteristics of HAH in members of an expeditionary unit to the Kanchenjunga base camp in Nepal (5100 metres).

4 Research A study analysed the incidence, risk factors and clinical characteristics of HAH in members of an expeditionary unit to the Kanchenjunga base camp in Nepal (5100 metres). Participants were monitored before and during the trek. Any headaches they experienced at greater than 3000 metres were recorded using a structured questionnaire incorporating the diagnosis for HAH and acute mountain sickness. In addition, 19 trekkers from other groups above 3000 metres recorded features of headaches using the same questionnaire. 83% of participants reported at least one HAH at a mean altitude of 4723 metres. [1.]. Those who developed HAH were significantly younger than those who did not, suggesting that age-related cerebral atrophy (loss of brain cells) might accommodate mild cerebral edema (or swelling). HAH was also more prevalent in women and people who have every day headaches. 95% of women in this study reported headaches compared to 82% of men; women also described their headaches as being of greater severity than those of the men. HAH often awakened the study participants from sleep or occurred upon wakening and was exacerbated by bending, coughing or sneezing, suggesting the possibility of intracranial (meaning within the cranium or skull) hypertension as a contributing factor.

strenuous exercise at high altitudes, can help. Avoiding alcohol and ensuring you keep well hydrated can also help minimise the risk of developing HAH.

5 Treatment There are no specific treatments for HAH. However, individuals have reported that preventative strategies such as a slow ascent at a rate of 300 metres a day, allowing two days of acclimatisation before doing any strenuous exercise at high altitudes, can help. Avoiding alcohol and ensuring you keep well hydrated can also help minimise the risk of developing HAH. Rescue treatments (to take when the headache occurs) include simple analgesics, such as paracetamol or ibuprofen. HAHs appear to respond well to these painkillers. Acetazolamide (paracetamol) 125mg, two or three times daily, may also act as a preventative and reduce an individual s susceptibility to acute mountain sickness. [2., 3.].

pulmonary edema or HAPE. This is very rare; if you do have any concerns, please speak to your healthcare professional.

6 FAQs Can acute mountain sickness be dangerous? Acute mountain sickness is relatively benign. In extreme cases, acute mountain sickness may progress to rarer syndromes, such as high-altitude cerebral edema (swelling of the brain) or HACE, and highaltitude pulmonary edema or HAPE. This is very rare; if you do have any concerns, please speak to your healthcare professional. I have migraine, can I take my triptans at high altitude? Triptans are still effective when taken at high altitudes for migraines. However, one study found ibuprofen 600mg was effective for HAH whilst sumatriptan 100mg was ineffective; there are no safety concerns. [4.].

7 Can you get HAH whilst travelling by plane? There is evidence that certain individuals can develop acute mountain sickness when they travel to terrestrial altitudes at which barometric pressures are the same as those in a commercial aircraft during flight. Whether HAH occurs in passengers in a commercial aircraft during flight is still unknown. There is a newly recognised form of headache that appears during flight when the plane is landing or taking off. The underlying cause is currently unknown, although sinonasal barotrauma has been implicated. Barotrauma means damage to tissues caused by a difference in pressure between the interior and exterior of an air space inside the body. Barotrauma of the ear is the most common type of barotrauma which develops when the air pressures on the two sides of the eardrum are not equal. Based on the few reported cases, aeroplane ascent- and descent-triggered headache is characterised by sudden onset, severe pain mainly on one side of the head, in the area of the eye, temple and at the front of the head, or sometimes situated near the side or top of the skull and facial regions. The symptoms rarely last more than one hour and the pain has been described as jabbing, stabbing and sharp. Other symptoms that can be experienced, although rarely, are: Watering of one eye Nasal congestion A stuffy feeling of the face. If you do experience a sudden and severe headache whilst travelling by plane, please speak to your healthcare professional to get a diagnosis. Your doctor may offer you treatment options, such as an antihistamine and / or a nasal decongestant [5., 6.]. spray.

8 Web: For further information, advice on migraine management and for updates on the latest migraine research, please contact Migraine Action by calling , ing or visiting the charity s website at All of our information resources and more are only made possible through donations and by people becoming members of Migraine Action. Visit to support one of our projects or visit to become a member. With thanks to: Migraine Action would like to thank our Medical Advisory Board for providing and reviewing information used in this booklet. References 1. Rodway G. W., Hoffman L. A., Sanders M. H.; High altitude-related disorders part 1: Pathophysiology, differential diagnosis, and treatment; Heart Lung 2003, Nov-Dec, 32(6): Imray C., Wright A., Subudhi A., Roach R.; Acute mountain sickness: pathophysiology, prevention, and treatment; Prog Cardiovasc Dis May-June, 52(6) Brundrett G.; Sickness at high altitude: a literature review; J R Soc Promote Health, 2002 March, 122(1): Burtscher M. et al; Ibuprofen versus sumatriptan for high-altitude headache (letter); Lancet Vol 346, July Evans R. W., Purdy A., Goodman S. H.; Airplane descent headaches; Headache 2007 May; 47(5) Berilgen M. S., Mungen B.; Headache associated with aeroplane travel: report of six cases; Cephalalgia 2006 June, 26(6): Bibliography MacGregor A.; Understanding migraine and other headaches; 2006, London, Family. Web resource: Web resource: 4 th Floor, 27 East Street, Leicester. LE1 6NB. Tel: Fax: info@migraine.org.uk Web: Registered Charity No Copyright 2010 Migraine Action Version 2 Reviewed February 2013 Next Review Date January 2015 This publication provides information only. Migraine Action and its officers can accept no responsibility for any loss, howsoever caused, to any person acting or refraining from action as a result of any material in this publication or information given. Whilst this booklet has been reviewed for accuracy by members of Migraine Action s Medical Advisory Board and other experts, the information does not necessarily reflect the views of individuals. Medical advice should be obtained on any specific matter.

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