What is the treatment for elevation headaches?

Treatment for Elevation Headaches

For elevation headaches, NSAIDs such as ibuprofen are the first-line treatment due to their proven efficacy and safety profile. 1

Understanding Elevation Headaches

Elevation headaches, also known as high altitude headaches (HAH), typically occur within 24 hours after ascending to altitudes of 2,500 meters (8,200 feet) or higher. These headaches can occur in isolation or as part of acute mountain sickness (AMS), which includes additional symptoms.

Pathophysiology

• Likely caused by hypoxemia-induced intracranial vasodilation and subsequent cerebral edema 2
• Prostaglandins appear to be important mediators between hypoxia and headache development 3
• Involves activation of the trigeminovascular system through chemical or mechanical stimulation 4

Treatment Algorithm

First-Line Treatment

• NSAIDs: Ibuprofen (400-800 mg every 6 hours) or naproxen sodium (275-550 mg every 2-6 hours) 5
  • Ibuprofen has been shown to significantly reduce headache severity and provide faster relief compared to placebo 1
  • The effectiveness of cyclooxygenase inhibition suggests prostaglandins play an important role in HAH 3

Second-Line Treatment

• Acetaminophen plus aspirin plus caffeine combination if NSAIDs are contraindicated or ineffective 5
• Triptans (sumatriptan, rizatriptan, zolmitriptan) for moderate to severe headaches not responding to NSAIDs 5

For Severe Cases or Those with Nausea/Vomiting

• Non-oral route of administration (nasal sprays, injections) 5
• Add antiemetic (metoclopramide 10 mg) for associated nausea 5

For Prevention

• Acetazolamide (125-250 mg twice daily) starting 24 hours before ascent 3
• Gradual ascent (not ascending too quickly) remains the most effective prevention strategy 3
• Combined acetazolamide and aspirin may provide the most beneficial preventive effects 3

Special Considerations

• Warning signs for progression: Monitor for symptoms of high altitude cerebral edema (HACE) including ataxia and altered mental status, even in the absence of headache 6
• Descent is definitive treatment: For severe symptoms or signs of HACE, immediate descent is the most effective intervention 6
• Avoid opioids and butalbital-containing medications for elevation headaches 5

Common Pitfalls to Avoid

1. Delayed treatment: Begin treatment as soon as headache develops rather than waiting for it to become severe 5
2. Ignoring warning signs: Headache may progress to more serious conditions like HACE or high altitude pulmonary edema (HAPE) if ignored 2
3. Medication overuse: Be aware of medication overuse headache risk with frequent use of acute medications 5
4. Inadequate hydration: Maintaining proper hydration is important at high altitudes 5
5. Continuing ascent despite symptoms: Failure to acclimatize properly before further ascent can worsen symptoms 3

For optimal outcomes, treatment should begin at the first sign of headache, and preventive measures should be considered for those with known susceptibility to elevation headaches or when rapid ascent is unavoidable.