High Altitude Headaches

Snow is falling gently on the mountains, and if you’re an avid skier, you probably can’t wait to hit the slopes with family and friends. But perhaps you’re prone to developing a nagging problem whenever you venture up into the mountains to ski. As you climb higher and higher, you develop a headache, maybe in the front of your head or in your temples. What you’re experiencing is not all that uncommon. It’s called an altitude headache, and it sure can put a damper on a ski trip! Whether you’ve had altitude headaches in the past or you just want to be proactive on an upcoming adventure, information is your friend. Here, we’ll cover the basics of altitude headaches, their causes, how to treat and prevent them, and when you really need to be worried. The only thing aching at the end of your ski trip should be your tired legs and arms.

What is an Altitude Headache?

Put simply, an altitude headache is a headache that develops when you ascend to greater heights above sea level. However, the technical definition is a bit more narrow. The International Headache Society, or IHS, has developed specific criteria which, if met, classify a headache as an altitude headache.

Altitude Criteria

First, the headache needs to develop within 24 hours of ascending to an altitude over 2,500 meters. If you climb to 1,000 meters and develop a headache, it is probably another type of headache unrelated to the altitude.
Second, the headache needs to resolve within eight hours of you coming back down to a lower altitude. If the headache lingers long after this, it may not have been due to the altitude in the first place — it could be a migraine or a sinus headache.

Headache Criteria

The headache itself must also meet certain criteria in order to be considered an altitude headache by the IHS definition. It must have at least two of these characteristics:

– Dull or pressing feeling
– Mild to moderate in intensity becomes worse when you exert yourself, move, strain, or bend
– Occurs bilaterally (on both sides of the head) and mainly experienced in the front of the head or around the temples

What Causes Altitude Headaches?

This is a hot topic in the headache research community. Researchers have not yet pinned down a specific mechanism that triggers these headaches. Well-meaning friends and ski buddies have had reassured you in the past that your headaches are just due to a lack of oxygen at higher altitudes, but this does not appear to be the case. At least, it’s not the sole cause of altitude headaches. The prevailing theory — one that has quite a lot of support from known biological mechanisms but has not been confirmed experimentally — is that the symptoms are due to the swelling of blood vessels in the brain at a high altitude. At altitude, there is less pressure on your body’s tissues, which could trigger the blood vessels to swell. This could explain why altitude headaches and migraines feel so similar, as migraines are also thought to be related to irritation of the blood vessels in the brain.

How Can You Treat Altitude Headaches?

Your headache does not have to ruin your ski trip! Thankfully, researchers know more about treating these headaches than they do about what causes them. If you descend to a lower elevation, your headache should dissipate rather quickly. If descending is not an immediate option, at least stop climbing any higher. Stop and rest, avoid alcohol and smoking, and drink plenty of water, which will help re-establish your fluid balance and alleviate the swelling in your blood vessels.

How Can You Prevent Altitude Headaches?

Obviously preventing a headache in the first place is preferable to waiting to see whether one develops. Here are a few easy strategies you can use. Give yourself time. Spend a couple of days at an altitude of around 3,000 meters before you go any higher. This gives your body — especially your vascular system — time to adjust to the lower pressure. The generally recommended timeline is to ascend no more than 300 meters per day. Stay hydrated. It’s common for people to become dehydrated on ski trips because they don’t feel like drinking in the cold. However, dehydration can contribute to altitude headaches or make them worse. Keep a water bottle with you, and make sure you’re drinking throughout the day. Also avoid alcohol, which dehydrates you further.

Take it easy. This is sometimes easier said than done on a ski trip, but if possible, try to avoid overly strenuous activity on your first day or two at altitude. Stick to the more friendly slopes and don’t push yourself at first. Sleep at lower altitudes. Book a cabin at the base of the mountain, and ride up to ski — rather than staying at the top of the mountain. You can also talk to your doctor about medications to prevent headaches when you travel to higher altitudes. The medication acetazolamide, which is commonly used to treat glaucoma and hypertension, has been found to be particularly effective. It works by increasing the amount of bicarbonate your kidneys excrete. This, in turn, lowers the pH of your blood, which increases the amount of oxygen in your blood, which helps prevent the blood vessels in your brain from swelling. A doctor can prescribe this medicine to help prevent the headache.

When Do You Need to Worry?

Is an altitude headache ever more than a headache? Is there ever a reason to seek emergency medical attention for this type of pain? Yes, and yes. You need to be aware. High-altitude cerebral edema, HACE, is a condition in which the brain swells due to lack of oxygen. This is most likely to occur when you travel to high altitudes very quickly with no acclimatization time. Along with a headache, weakness, nausea, loss of coordination, confusion, and hallucinations. HACE can be fatal, so if you develop these symptoms, seek medical care immediately and move to a lower altitude. High-altitude pulmonary edema, HAPE, sometimes also occurs alongside an altitude headache. It is a buildup of fluid in the lungs, leading to trouble breathing, a cough, tiredness and weakness, and tightness in the chest. HAPE can appear after you’ve been at altitude for a few days. As with HACE, seek medical care immediately. Many people experience headaches when they travel to a higher altitude. Thankfully, there are ways to manage and prevent these headaches so you can enjoy the slopes. Above all else, keep an eye on your symptoms to ensure you’re not developing the more serious HACE or HAPE.

If you have further questions about altitude headaches or would like personalized care from a headache doctor, contact me, Dr. Risa Ravitz, to schedule a consultation.