It is remarkable how many people mistakenly believe that a headache at altitude is "normal" when it is actually AMS. Be willing to admit that you have altitude illness .

How to Avoid AMS

The key to avoiding AMS is a rational ascent that gives your body time to acclimatize. People acclimatize at different rates, so no absolute statements are possible, but in general, the following recommendations will keep most people from getting AMS:

At altitudes above 3000 meters (10,000 feet), your sleeping elevation should not increase more than 500 meters (1500 feet) per night, and every 1000 meters (3000 feet) you should spend a second night at the same elevation.

What To Do If You Have AMS

We emphasize : DO NOT ASCEND ANY HIGHER.

High Altitude Cerebral Edema (HACE)

AMS is a spectrum of illness, from mild to life-threatening. At the "severely ill" end of this spectrum is High Altitude Cerebral Edema; this is when the brain swells and ceases to function properly. Obviously, this is a Bad Thing to have happen to you.

HACE, once present, can progress rapidly, and can be fatal in a matter of a few hours. Persons with this illness are often confused, and may not recognize that they are ill.

The main symptom of HACE is a change in the ability to think. There may be confusion, hallucinations, changes in behavior, or lethargy. However, it is probably easier to recognize a characteristic loss of coordination that is called ataxia . This is a staggering walk that is identical to the way a person walks when very intoxicated on alcohol.

To test for this abnormal walk, have the sick person do a straight line walk (in medical speak this is called the "tandem gait test"). Be fair: do this on level ground, take off their backpack, and don't have them try it in big heavy boots. Draw a straight line on the ground, or have them follow a crack in the teahouse floor. Have them walk along the line, placing one foot immediately in front of the other, so that the heel of the forward foot is right in front of the toes behind. Try this yourself. You should be able to do it without difficulty. If they struggle to stay on the line (the high-wire balancing act), can't stay on it, or fall down, they fail the test and should be presumed to have HACE .

The treatment is immediate descent . This is of the utmost urgency, and cannot wait until morning (unfortunately, HACE often strikes at night). Delay may be fatal. The moment this is recognized is the moment to start organizing flashlights, helpers, porters, whatever is necessary to get this person down. How far down? At least to the last elevation at which they woke up in the morning with no symptoms of AMS. Bearing in mind that the vast majority of cases of HACE occur in persons who ascend with symptoms of AMS, this is likely to be the elevation the person slept at two nights previous. If you are uncertain, 500-1000 meters descent is a good starting point.

People with HACE usually survive if they descend soon enough and far enough, and usually recover completely. The staggering gait may persist for days after descent. If recovery has been complete, and there are no symptoms, cautious re-ascent is acceptable.

High Altitude Pulmonary Edema (HAPE)

Another form of severe altitude illness is High Altitude Pulmonary Edema, or fluid in the lungs. Though it often occurs with AMS, it is not felt to be related and the classic signs of AMS may be absent. Symptoms of HAPE include any of the following:

• Extreme fatigue
• Breathlessness at rest
• Cough, possibly productive of frothy or pink sputum
• Gurgling or rattling breaths
• Chest tightness, fullness, or congestion
• Blue or gray lips or fingernails

The treatment for HAPE is the same as for HACE: immediate descent . As with HACE, it is of the utmost urgency; delay may be fatal . The same rules apply for how far as well: to the last elevation where the victim felt well upon awakening.

Whereas HACE descent is complicated by confusion and staggering on the part of the victim, HAPE descent is complicated by extreme fatigue and possibly also due to confusion (due to inability to get enough oxygen to the brain). HAPE frequently occurs at night, and may worsen with exertion.

HAPE resolves rapidly with descent, and one or two days of rest at a lower elevation may be adequate for complete recovery. As with AMS, once the symptoms have fully resolved, cautious re-ascent is acceptable.

It is common for persons with severe HAPE to then also develop HACE due to the extremely low levels of oxygen in their blood (equivalent to a continued rapid ascent).

DO NOT WAIT UNTIL MORNING. Descend at least to the elevation where you last felt well when you woke up.

People sick with AMS can get worse, and may need help descending, or may not recognize that they are getting sicker.

Things to Avoid

Respiratory depression (the slowing down of breathing) can be caused by various medications, and may be a problem at altitude. The following medications can do this, and should never be used by someone who has symptoms of altitude illness (these may be safe in non-ill persons, although this remains controversial):

• Alcohol
• Sleeping pills (acetazolamide is the sleeping tablet of choice at altitude)
• Narcotic pain medications in more than modest doses

How to recognize high altitude headaches:

Trekkers always wonder about how to tell if a headache is due to altitude . Altitude headaches are usually nasty, persistent, and frequently there are other symptoms of AMS; they tend to be frontal (but may be anywhere), and may worsen with bending over. However, there are other causes of headaches, and you can try a simple diagnostic/therapeutic test. Dehydration is a common cause of headache at altitude. Drink one liter of fluid, and take some acetaminophen or one of the other analgesics listed above. If the headache TOTALLY resolves (and you have no other symptoms of AMS) it is very unlikely to have been due to AMS.

The main treatment of AMS is rest, fluids, and mild analgesics: acetaminophen (paracetamol), aspirin, or ibuprofen. These medications will not cover up worsening symptoms. Descent is always an option, and recovery will be quite rapid.

 Trekking Tips

1. If you can walk, you can hike.

2. Keep fit before doing a trek, it is very important to be as physically fit as possible and some form of fairly strenuous exercise should be engaged in daily for at least a month before leaving.

3. Practice; start with beginner-rated trails of a mile or less and then work your way up to longer, more difficult hikes.

4. It is strongly recommended to get a proper aclimatization before your trek; stay some 3 to 4 days at high altitude before your hike starts.

5. Walk Slowly but keep steady (unless you are trying to set a new record).

6. When planning your trip, it is advisable to have a medical check up explaining to your physician the altitude you hope to reach.

7. Never panic, it is normal to get short of breath with a higher pulse rate; when on the trail, let your Guide know if you feel ill or have severe headaches, dizziness, nausea, dysentery or just bad blisters.

8. Please insure yourself against sickness, accident, helicopter evacuation, hospitalization and the like, as you would normally do before embarking on a wilderness vacation.

9. Use walking poles; properly used they can reduce up to 30% of the effort you make in you legs, speacially in your nees!

10. Walking boots; never buy new ones for just your trek, it is preferable to take those you are already used to with thick (synthetic fiber) socks.

11. Keep Hydrated, this is very important at all times.

12. Always carry a good waterproof jacket and gloves.

13. Walk always into the Mountain side (rather than on the clifff side).

14. Keep dry if it rains or got wet from the swet.

15. Keep always a Positive Menthal Attitude.

16. Got some other tips? Please share with us!
     

Have a wonderfull trek!