High Altitude Pressure/Pain – Cures and fixes?

First of all, it has been my experience that about 80% of all of the headaches that people experience at altitude come from dehydration, and that ought to be easy to fix. However, the thirst mechanism does not keep up with the body's water balance. Many hikers do not seem to want to relieve themselves out there, so they avoid that by not drinking enough water in general.

Most people who experience the ordinary light symptoms of altitude resort to OTC analgesics and a good night of sleep, and that keeps them stable. Dramamine can be a mild sedative to aid in sleep.

If you know that you'll get symptoms, then ask your physician to prescribe Diamox.

For most hikers, this has nothing to do with pressure in the ears, as you suggest.

–B.G.–

The safest way to avoid altitude sickness is to acclimate slowly to higher altitudes.
If she knows she gets sick at 7,000 feet (and you have eliminated the dehydration issue as a possibility), then it is best to start at a lower altitude. Possibly with day hikes at 5,000 feet and sleeping at 4 or 5k…. then another at 7,000… then 9000… over a period of days or a week.

I realize that may not fit into your schedule, but also understand that you could be playing with something that is deadly. People can die from altitude sickness. I wouldn't normally suggest something so dire, but some people are MUCH more prone to it and have MUCH worse consequences than normal. And it is a bit unusual for people to get altitude sickness at something as low as 7,000 feet. So… my guess is that it is either NOT altitude sickness and maybe is something like Bob suggests… dehydration… OR… she could be especially sensitive to altitude and there could be a danger lurking there. I for one do not recommend taking drugs to prevent altitude sickness as I prefer to avoid drugs if possible. Drugs can have side effects. And if you use the drug to get you up to altitude and it stops working for some reason, then you will find yourself way out an a limb… potentially a deadly one.

Billy

A couple of years ago, I was going to hike up and down a 14,000 foot peak one day. I parked my car at 11,500 feet, went to the summit, and then I was returning late in the afternoon. When I got down to almost 12,000 feet, I saw a military formation, forty or so men, moving up the mountain, and this was an extremely unusual sight on this mountain. Everybody had a full pack, and they were apparently going to camp out overnight somewhere toward the summit. They had started at 12,000 feet without any acclimatization. I stood there in amazement as they passed, and then I asked somebody what it was all about. Apparently these were all medics, half from the Army and half from the Navy (Marines). They were all soon to go to eastern Afghanistan where there are some high elevation bases.

It seems that the Department of Defense knew all about Diamox, but there are some side effects, and they wanted to work around that, so there had been some new secret drug development program underway for a while. They were testing out the new drug on these medics. Perhaps one third were taking the new drug, one third took Diamox, and one third took a placebo. I would sure hate to be in the bunch stuck with the placebo.

–B.G.–

I get headache when I go above about 10,000 feet. When I was on Rainier at 14,000 it was horrible. But when I go back down it's fine.

When acclimatizing on Everest, they hike up to some elevation, then go back down a few thousand feet and camp overnight.

So, maybe hike up to 10,000 feet, go back down to 7,000 feet and camp, maybe next day you can go up to 12,000 feet?

I'm going to suggest they spend a day or two at my place which is exactly at 4500ft and then camp a day at 7000-8000ft and then start backpacking the next day.

I doubt it's dehydraton given she says she feels terrible when they drive up into the mountains and it hits within the first hour. That's of course assuming she isn't already dehydrated when they hit the trail.

Look for articles on the consequences of ignoring elevation related symptoms. Personally, with someone who gets symptoms that low, if it is important that you all go somewhere together I would choose a different destination that isn't high elevation.

After talking with her it's not dehydration. She drinks a TON of water, between 8 and 10L a day on the last backpacking trip they went on. She said she is going to see the doctor because even though she drinks a ton she doesn't feel bloated and she doesn't urinate all that much. Drinking that much water I'd have to go every five minutes.

She has other health issues that she has alluded to but hasn't gone into specifics. I'll have to chat with my brother and see if we can find some lower elevation backpacking here. It seems like everything that would be multi-day and with reasonable temps in the summer is high altitude. I'm not a Utah native so I'm still learning the trails. Shoot, most the day hikes here start at about 6500ft and many 9k.

“She drinks a TON of water, between 8 and 10L a day… “

That is Huge amount of water!

IF it is true, Hyponatremia is possible.

Greg, that's exactly what I was thinking after she told me how much she was drinking. That's twice the amount I would normally drink during a full day's worth of backpacking.

With that kind of water consumption she could have a serious electrolyte imbalance and it wouldn't surprise me if she were seriously potassium deficient which will contribute to the headaches.

I suppose that each human body is different, but I've found my own personal solution [pun intended] to high altitude water balance. I carry two bottles. One is full of water, and one is full of some sports drink with electrolytes. If I am just a little thirsty, I drink water. If I am feeling low on energy, I drink the other stuff. As a result, I generally keep a reasonable water balance, keep some energy, and keep some electrolytes.

That's why it is important for each hiker to spend a day or two at moderate altitude, so they can determine just what kind of mix they need to drink to stay normal.

–B.G.–

Headaches are a classic symptom of mild altitude sickness. The "pressure" you mention – and I'm assuming you mean pressure felt in the ears or sinuses – is not, except in the case of extremely rapid changes in altitude like you get in a vehicle. All the discussion of hydration and gradual acclimatization applies very well to the headache and to typical altitude sickness, but may have little or nothing to do with the pressure issue you describe. I would be very cautious about this. A very gradual approach to altitude and being ready to descend right away seems like the only safe bet. A visit to an ENT doc would be a good idea to find out why she has this issue – it may be due to internal structural issues in sinuses or eustachian tubes.

I'm curious as to how long acclimatization lasts after you return to sea level. I'm sure this has been studied. Could you just go hang out for a few days at an easily accessible high altitude the weekend before, and then the next week get some benefits on your high mileage trip? What about 2 weeks later? Though I suppose what people are talking about here is due to something shorter term than the increase carrying capacity of the blood.

The conventional wisdom is that acclimatization lasts for about as long as it took to get it.

In the short term, and for moderate elevations (like 10,000 feet), the acclimatization affects your respiration and heart rate, but not the blood very much. Long term acclimatization to higher elevations (like 20,000 feet) involves an increase in red blood cells, but that requires chronic hypoxia for a week or two, just to get it started.

If you were hiking along the JMT for a few weeks and then return to sea level for a couple of days, it will all be lost.

–B.G.–

What I've been told, and it works pretty well for me, is to drive up as high as you can and spend most of the day sitting or doing gentle walking (no pack for her, and no pushing it as far as speed or climbing) to acclimate – then sleep at a lower elevation (back at your house). The next day they could repeat that, then camp higher, as you planned.

If you drive up to 9K the first day and she feels bad just sitting around, drive back down to 8K or 7K and see if she feels OK there.

I live at about 6,000 feet. I have found that a couple of days at sea level and I don't lose much, if any. But a week and I notice the difference when I return to altitude.
I have read that it takes about a week to 'fully' acclimate to a particular altitude and about the same to 'fully' lose it. That said, each day at altitude you should feel better at that altitude.

Would going to altitude one weekend give benefit for the next weekend? I am pretty sure it would not. But a couple of days at altitude the day before starting a backpack certainly does help.

Billt

Eric. My wife and I are headed outta Utah after the 4th. We are from michigan. We will be hiking up kings peak. What we plan on doing is staying at her sisters place in salt lake and doing some day hikes up some mountains. (Mt Olympus). Kings peak is the last thing we are doing in Utah. So hopefully we will be acclimated to the altitude by then. If need be we will spend a day at Henry forks and theme hike out from there taking our time to soak in the scenery.

Nathan, I don't think you'll get much benefit from sleeping/living in SLC which is only ~4,300 feet. Most folks can handle at least 8,000 feet initially. So you'll want to maximize the time spent at higher elevations and minimize time in SLC.

Bob, et al., the literature I've seen on adaptation to sea level after time at altitude places hematocrit adaptation at around ~3 weeks (one example is http://www.ncbi.nlm.nih.gov/pubmed/18204195) and it is roughly linear.

Eric, besides Bob's great advice on hydration, also consider diet. The body will be breathing heavier to get more oxygen and compensating for the resulting alkalosis by urinating bicarbonate. Drinking water helps with both. She may also want to consider reducing salt intake and other dietary adjustments to help acid/base balance. Plus she may want to consider increasing iron intake. (one source is http://www.rice.edu/~jenky/sports/altitude.html).

On the pressure, I'm guessing she has experienced the problem on planes which are pressurized to the equivalent of about an 8,000 feet. I think if she could describe a location a Dr. could diagnose it as something specific — perhaps it's Aerosinusitis or some other ailment. If it's felt more in the ears and eustachian tubes, Earplanes help some people.

"Bob, et al., the literature I've seen on adaptation to sea level after time at altitude places hematocrit adaptation at around ~3 weeks (one example is http://www.ncbi.nlm.nih.gov/pubmed/18204195) and it is roughly linear."

David, you are completely missing the point.

There are two different types of adaptation to altitude. The first type is short term, and that mostly consists of deeper breathing, faster breathing, and faster heart rate. That happens quickly upon arrival at altitude and is maintained throughout. If you are going to someplace high in Utah, you will see this.

The second type is long term, and it mostly consists of increased red blood cells, perhaps measured as increased hematocrit. That takes a few days to even begin, and it takes about three weeks or so to maximize. At moderate elevations, you don't see a lot of this, but it is more pronounced at high elevations. If you are going to Mount Everest, you will see this.

–B.G.–

Hi Bob,

Absolutely there are short and long-term adaptations — my comments are in line with that. My hematocrit comment is in regards to the long-term adaptation and the study I referred to happens to be for ~11,500 feet vs. sea level. The acid/base comment is in regards to the short term adaptation.

Dave

It seem unlikely that actual pressure differences, the type you feel driving up and down mountains and especially on airplanes, would be involved as those usually equilibrate on their own in minutes. However, though this may already be known to most, there is a very easy way to fix this kind of pressure imbalance, much more direct than chewing gum, and this is the classic diver's technique. Pinch your nose and attempt to lightly blow out with your mouth closed if you are going down (increasing external pressure) or suck in in the same way if you are going up (decreasing pressure). If you are unsure you can switch back and forth a bit between modes. If there really is a pressure difference in the inner ear then you will feel it when it equalizes, and possibly even your hearing will suddenly be less muffled as your eardrum will have less pressure on it.

I really doubt this is what is going on as the actual "pressure" by itself is not what causes altitude sickness, though I suppose she could have a very weird middle/inner ear. Probably the "pressure" is a metaphorical one relating to the headaches.

Such as pulmonary and cerebral edema.

Concise wrap-up here.