Dr. Akash Mehta is an Emergency Medicine board-certified specialist, health and fitness consultant, and Concierge Medicine physician based out of Los Angeles. After finishing medical school at the Touro College of Medicine in Manhattan, Dr. Mehta completed his Emergency Medicine residency at Mount Sinai Medical Center in Miami Beach. Then Dr. Mehta joined Kaiser Permanente as an Emergency Medicine attending physician in West Los Angeles. After years of obtaining intricate knowledge of the healthcare system, he decided to branch on his own and create Nyla Health. He continues to work with various Emergency Medicine groups in and around Los Angeles, and most notably had extensive experience in the frontline during the COVID-19 pandemic. 

Photo Credit: Shutterstock

Your annual ski trip is coming up. You set up an amazing itinerary for you and your partner. She bought you both some new ski jackets, and you made reservations for the newest restaurants in Aspen. The flight was smooth, and the view is picturesque from your resort room. You are both at dinner, and she asks you if you still have that headache from earlier, because she says she still has one. “Yea, it’s weird,” you respond. “I mean, we only had two drinks on the plane. I feel lightheaded too. Maybe we should hold on the wine right now.”

Sound familiar? If so, you have just experienced a mild version of acute mountain sickness, the most common of high-altitude medical illnesses! Here Haute MD expert Dr. Akash Mehta reviews the types of high altitude illness and their extremities.

What causes acute mountain sickness?

Sources vary in its prevalence, but anywhere from 20-80% of people experience this depending on the speed of ascent, the altitude reached and each individual’s susceptibility. Acute mountain sickness is usually defined as having a headache and other symptoms, like lightheadedness, nausea, difficulty sleeping; it can even lead to being off-balance and confused.

It usually occurs at an altitude above 7,000 ft. As alluded to earlier, the faster you ascend to that altitude, the worse it may be. And the most peculiar fact of all—it is not at all dependent on physical fitness, age, sex, smoking habits and previous high-altitude experiences! Yes, even an Olympic athlete may experience this while you may not.

How to treat acute mountain sickness?

The best treatment is descent, or at least terminating ascent (for mild symptoms) to acclimatize yourself to the altitude for 12-36 hrs. Next, you can try anti-inflammatories for a mild headache, such as ibuprofen. Other treatments would include prescription medicines both for treatment and prevention which can be spoken about with your medical professional.

Photo Credit: Shutterstock

What is high-altitude cerebral edema (HACE)?

All is not mild however in the world of high-altitude medicine. There are some dangerous conditions that need immediate attention. The first one of note is the least common but most dangerous form of acute mountain sickness—high altitude cerebral edema (HACE). HACE refers to having fluid accumulating in your skull, which starts causing pressure and damage to your brain! It almost never occurs under an altitude of 8000 ft, and typically occurs 3-5 days after arrival to the elevation. If you notice that you or someone else progressed from headaches and nausea to being confused, off-balance, or being difficult to arouse, please call 911 or get resort staff to help immediately. The affected person should be helped to descend immediately; if not possible, have them hyperventilate and see if the personnel has oxygen to provide for the affected individual until they are brought under the care of a medical professional.

What is high-altitude pulmonary edema (HAPE)?

The other very dangerous condition is high altitude pulmonary edema (HAPE). This is when fluid builds up in the lungs which can lead to severe shortness of breath and worse! This is the most lethal of all the high altitude illnesses, where 50% of cases can lead to death if the affected person does not complete descent immediately. Just like all high-altitude illnesses, rapid ascent is the main risk factor. Other risk factors include heavy exertion, very cold temperatures, excessive salt ingestion, current respiratory issues, and the use of sleeping medication. New shortness of breath at high altitudes should not be ignored, and the affected individual should seek emergency medical care immediately. Again, have the affected person descend and try to find oxygen support for them until they are taken under emergency medical care.  Other medicines/treatments for HACE and HAPE need to be administered or prescribed by a medical professional.

What is the best method to avoid any high-altitude illness?

As you may have deciphered, the primary method to avoid high-altitude illnesses is to gradually ascend to your altitude. Even if it is a damper in your itinerary, it may help to have an overnight stay in a hotel or layover in a city with an increase in altitude as you make your way to your more elevated destination. Two prescription medicines that have been shown to help in prevention are acetazolamide and dexamethasone (a steroid); you can talk to your primary care doctor about whether you are a candidate for these.

All in all, changes in elevation should be treated as their own environment for which one’s body must adapt. Just like you would layer your clothes for a day that is 5 degrees Fahrenheit, let your body acclimate to the new altitude with a slow ascent.

Remember that confusion and excessive sleepiness could be signs of HACE, and new and significant shortness of breath could be a sign of HAPE. Any of these signs should prompt you to seek immediate medical attention. Safe high altitude travels to all during this winter, and remember that the nagging headache at the ski resort may simply be more than a hangover.