Altitude Headaches...

I am new to the Forum and just had a question for everyone...

I have always had an issue with headaches when I get about 7 to 8000 feet above my acclimated altitude (for example, I live in Las Vegas, 2100ft, and when I get to about 10000ft). When I get above that altitude I start getting headaches and they pretty much don’t go away till I am back down to a manageable altitude or a few days of being at the altitude.

Are there any recommended treatments while at altitude?

I've studied this quite a bit since my then teenage daughter developed symptoms of AMS (Acute Mountain Sickness) on a backpacking trip in Colorado. Your headache is one of the first symptoms of AMS. Your body is trying to get more oxygen to your brain so is sending more blood there. Other symptoms are malaise ("I feel awful"), loss of appetite, nausea, sleep disturbances, peripheral edema (swelling of limbs), cyanosis (blue lips).

The only cure for AMS is to descend. Prevention through more gradual acclimatization is the way to go. There are two methods of acclimatization. One is the "climb high, sleep low" method in which you climb up high during the day but descend to sleep at an altitude at which you are comfortable. AMS is more apt to develop during sleep, when your metabolism drops. The second method is to ascend no more than a net of 1,000 to 1,500 feet between sleeping places each night. Resting a day or two after you first get to higher altitude is also a good idea.

Adequate hydration is extremely important at high altitude. Your body is trying to increase its metabolic rate, requiring more fluid, and the air is very dry at high altitudes. Drink more fluids than you usually do and consider adding some kind of electrolyte mixture. A high-carbohydrate diet is also recommended.

Severe headache not relieved by an acetaminophen (Tylenol) or difficulty breathing with the onset of chest congestion are symtoms of High Altitude Cerebral Edema and High Altitude Pulmonary Edema. Both are life-threatening medical emergencies, and immediate descent is required because they can kill quite fast.

You might ask your physician about Diamox (acetazolamide) as a possible aid to acclimatization. It is more effective as a preventive measure than as a cure after symptoms develop. EDIT: Like any drug, it can have side effects, especially if you're allergic to sulfa drugs (which this drug is).

Some sources:
Altitude Illness: an excerpt from NOLS Wilderness First Aid
Outdoor Action Guide to High Altitude

OM pretty much said it all. There are other threads here on AMS. One thing I would add-HAPE is nothing to fool with. A headache from AMS is painful, but anything more serious can kill you and quickly. I'm not saying this to scare you, but I'm speaking from personal experience.

I woke up one morning at 11.5K with what I suspect was HAPE. The doctors called it pneumonia, but I'm sure it was HAPE. Whatever it was, I was coughing up blood so I knew right away I was in trouble.

Fortunately, I wasn't camping. I was at home in a big city in the Andes. Straight to the clinic where I stayed hooked up to oxygen and an IV for about a week.

I wouldn't try toughing it out in the wilderness because you may not be able to get treatment in time.

I've skied my brains out for many years without a problem on some very high mountains....then...a few years ago I got permission to set up telescopes and camp for three nights on Mt. Evans, Colorado.
My house is at 618 ft. above sea level. We drove to Mt. Evans and set up in one day (14,240 ft.)! At about midnight the first night, the headaches began. The second day, it was 70 deg. and I was wearing insulated coveralls an a parka...couldn't get warm. By the second night, I was throwing up, and our food/water intake was probably 1/4th what it should have been. You don't care to eat or drink and nothing helped the headaches.
We bailed out on the third day and upon hitting 9,000 ft. ALL symptoms disappeared. It was a painful lesson but the sure fire fix is to lose altitude!
A doc friend said he could have prescribed a steroid but....why? Getting aclaimated makes the most sense, or simply don't go up mountains when you live at sea level.

I just had my first experience with altitude, teaching in Colorado. The actual town I was teaching in wasn't too bad at 6700 ft, but traveling from Denver I could definitely tell a difference when I went over the Continental Divide!

Like OM said, the basic problem is increased pressure because your brain swells, either because you're sending moe blood there or because cells are dying and releasing fluid. In either case, you wind up with more stuff in a fixed space, and the result is increased pressure. It manifests as headache, nausea/vomiting, that sort of thing. Should you or one of your party develop ataxia (stumbling gait, similar to being a little tipsy) or some sort of altered mental status, GET DOWN! You've entered the realm of HACE, and while an injected steroid like dexamethasone might buy you some time to walk down, the only treatment is to descend, and fast.

OM pretty much nailed the treatment. Diamox can be used to prevent AMS, along with hydration and nutrition. Ibuprofen or Tylenol can symptomatically treat the headache. But bottom line, if you develop AMS, you've gone up too far to fast. Take a rest day, descend, or both, but don't go any higher until your symptoms resolve.

I want to add that I've gone from sea level to 7600 in Yosemite in a day without any problems and that includes doing some strenuous work on skis pulling a sled. The one time I got sick there was from food poisoning, not altitude, but being that high didn't help things at all. I've skied all day at around 8K with no problems, but I think too much higher might be pushing it. The time I got HAPE, I was 18, so age isn't a factor as far as I can tell.

part of the problem is that your brain swells "edema" and it is squeesed into your skull tighter than Paris's jeans. At some point this squeesing starts to cut off the blood supply, then going down or being put into a pressurised "barrobag" is the only solution. If only we could build homes with bedrooms that simulated 5,000 of altitude that wouldn't explode at sea level.
Jim

There are "simulators" of this type on the market.
http://www.altipower.com/
and a local version :
http://www.go2altitude.com/mountaineering.php
(no experience here...)
Franco

We drove up Pikes Peak last week and when I went into the restroom at the summit, there was a boy being attended to by an EMS due to altitude sickness. As I was leaving, another boy was entering and slumped to the floor. I found out his symptoms and communicated to the EMS around the corner that we had another one. I got him situated and went and found another EMS to attend to him.

One of the reasons we went up was because the next day I was doing Mt. Democrat, Mt. Cameron and Mt. Lincoln, all of which are above 14,000', so I wanted some acclimation. Thankfully, I haven't had any real problems and that includes a trip where I was at sea level and 18 hours later was standing on the highest peak in the Rockies.

As you noticed, you are fortunate to be able to go that high that fast without problems! Some can, some can't! Those who can't need to slow down!

Everyone seems to be a bit different in how they react to high altitudes. Per what I've read and also heard in my recent Wilderness First Aid class, such things as physical fitness don't necessarily help. The young seem to be a bit more prone to altitude problems, as you also noticed.

Every ones ability to temporarily adapt to altitude is very different and has nothing to do with sea level conditioning. There is a standard deviation bell curve of where most people start to feel altitude in a negative way, and for me it was sometimes as low as 4,500', wheras some can go right up to 14,000' but I think its hard to do that without a very unusually high oxygen capability, more than a normal person has. So I believe most of the older books at lease councelled that going to 10,000' was probably the most one should shoot dor in a day, and then you can add 1,000' per day of sleeping altitude after that. You should climb to points higher than you will sleep during the day and then come down to sleep.

A 1500' DROP IS CONSIDERED ADEQUATE TO SAVE A PERSON FROM HAPE. If a party member has to go down with someone, generally 1,500 feet is eough, so always climb higher and sleep lower, this is one of the reasons for advanced camps going up Everest.

This might be another thread but I take it that there is no evidence that conditioning plays a role in being able to handle altitude. For example, if someone typically started showing symptoms at 7kft and really worked on their cardio, that they could stretch this out to 8 or 9k after some period of time. Or does it all seem to boil to acclimatization?

There are lots of stories about top mountaineers in peak condition fighting this problem...and like seasickness, it seems to be a bit arbitrary. That said, for any individual, being in better shape, and better hyfrated, and slower acclimatization, will reduce the chance of having these.

If you take a bottle partially filled with liquid to high altitude, open it to use the contents, close the lid, and come back down, you will see the compression - the air is different up there. I've come back home to find my Nalgene (hard sided) with the sides pulled in because I sealed it shut on top of Mt Dana. Breathing is harder going up a couple thousand feet at 9 to 12,000 feet - hike on the coast from 500 feet to 5,000 feet and see how much easier it is to climb the mountain. Your physical condition doesn't change the amount of oxygen in the air. Your body can adjust over time to it, tho.

I've had a few symptoms related to altitude but don't get sick. Sometimes I have less of an appetite, once in a while I get lightheaded. But I have to be at 12,000 feet or more to get that way. Very happy about that - sulfa allergy means I can't take diamox.