High-altitude headache: a narrative review
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https://doi.org/10.48208/HeadacheMed.2025.40Keywords:
High-altitude headache, Hypobaric hypoxia, Acute mountain sicknessAbstract
Purpose of review
This narrative review aims to summarize current evidence on the epidemiology, pathophysiological mechanisms, risk factors, differential diagnosis, and preventive and therapeutic strategies of High-altitude headache (HAH) to raise awareness among physicians.
Recent findings
HAH is the most common neurological symptom associated with acute mountain sickness (AMS) and has become a global health concern due to the increasing exposure to high altitudes through tourism, sports and work. Its pathophysiology is complex and multifactorial, involving hypobaric hypoxia, blood–brain barrier dysfunction, and trigeminovascular system activation.
Conclusions
The diagnostic criteria of the ICHD-3 and the Lake Louise Score are highlighted as essential clinical tools, especially regarding moment of evacuation. Knowledge gaps were identified in areas such as biomarkers, updated epidemiological data, diagnostic standardization and vulnerable populations. Improving understanding and management of HAH is critical as global exposure to high-altitude environments continues to rise.
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References
1. Carod-Artal FJ. High-altitude headache and acute mountain sickness. Neurología 2014;29:533–40. Doi:10.1016/j.nrl.2012.04.015.
2. Olesen J, et al. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2018;38:1–211. Doi:10.1177/0333102417738202.
3. Burtscher J, Hüfner K, Kopp M, Schipplick F, Schobersberger W, Gatterer H. High altitude adaptation, common high-altitude disorders and the effects of high altitude on mental health. Sports Psychiatry 2024;3:197–208. Doi:10.1024/2674-0052/a000095.
4. Dietz TE, Hackett PH. High-Altitude Medicine. Travel Medicine, Elsevier; 2019, p. 387–400. Doi:10.1016/B978-0-323-54696-6.00042-2.
5. Łagowski W, Grodzka O, Domitrz I. Atypical neurological symptoms at high altitude: a systematic literature review. Travel Med Infect Dis 2025;66:102867. Doi:10.1016/j.tmaid.2025.102867.
6. Richalet J, Herry J. Médecine de montagne: Alpinisme et sports de montagne. France: Elsevier Masson; 2017.
7. Marengo A, Tejada M, Zirena IH, Molina S. Neurological Manifestations Associated with Exercise at Altitude. Curr Neurol Neurosci Rep 2025;25:29. Doi:10.1007/s11910-025-01418-6.
8. Marmura MJ, Hernandez PB. High-Altitude Headache. Curr Pain Headache Rep 2015;19:9. Doi:10.1007/s11916-015-0483-2.
9. Luks AM, Swenson ER, Bärtsch P. Acute high-altitude sickness. European Respiratory Review 2017;26:160096. Doi:10.1183/16000617.0096-2016.
10. Maini K, Schuster NM. Headache and Barometric Pressure: a Narrative Review. Curr Pain Headache Rep 2019;23:87. Doi:10.1007/s11916-019-0826-5.
11. West J, Schoene R, Luks A, Milledge J. High Altitude Medicine and Physiology 5E. 5th ed. London: CRC Press; 2012. Doi:10.1201/b13633.
12. Angelini C. Neurologic and Metabolic Challenges at High Altitudes. SVOA Neurology 2024;5:78–86. Doi:10.58624/SVOANE.2024.05.0132.
13. Aboouf MA, Thiersch M, Soliz J, Gassmann M, Schneider Gasser EM. The Brain at High Altitude: From Molecular Signaling to Cognitive Performance. Int J Mol Sci 2023;24:10179. Doi:10.3390/ijms241210179.
14. Berger MM, Luks AM. High Altitude. Semin Respir Crit Care Med 2023;44:681–95. Doi:10.1055/s-0043-1770063.
15. Burtscher M, Mairer K, Wille M, Broessner G. Risk factors for high-altitude headache in mountaineers. Cephalalgia 2011;31:706–11. Doi:10.1177/0333102410394678.
16. Richalet J-P, Larmignat P, Poitrine E, Letournel M, Canouï-Poitrine F. Physiological Risk Factors for Severe High-Altitude Illness. Am J Respir Crit Care Med 2012;185:192–8. Doi:10.1164/rccm.201108-1396OC.
17. Bian S-Z, Zhang J-H, Gao X-B, Li M, Yu J, Liu X, et al. Risk factors for high-altitude headache upon acute high-altitude exposure at 3700 m in young Chinese men: a cohort study. J Headache Pain 2013;14:35. Doi:10.1186/1129-2377-14-35.
18. Broessner G, Rohregger J, Wille M, Lackner P, Ndayisaba J-P, Burtscher M. Hypoxia triggers high-altitude headache with migraine features: A prospective trial. Cephalalgia 2016;36:765–71. Doi:10.1177/0333102415610876.
19. Queiroz LP, Rapoport AM. High-altitude headache. Curr Pain Headache Rep 2007;11:293–6. Doi:10.1007/s11916-007-0206-4.
20. Schneider M, Bärtsch P. Characteristics of Headache and Relationship to Acute Mountain Sickness at 4559 Meters. High Alt Med Biol 2018;19:321–8. Doi:10.1089/ham.2018.0025.
21. Bärtsch P, Swenson ER. Acute High-Altitude Illnesses. New England Journal of Medicine 2013;368:2294–302. Doi:10.1056/NEJMcp1214870.
22. Hofmeyr R, Tölken G, De Decker R. Acute high-altitude illness. South African Medical Journal 2017;107:556. Doi:10.7196/SAMJ.2017.v107i7.12612.
23. Paul S, Gangwar A, Bhargava K, Khurana P, Ahmad Y. Diagnosis and prophylaxis for high-altitude acclimatization: Adherence to molecular rationale to evade high-altitude illnesses. Life Sci 2018;203:171–6. Doi:10.1016/j.lfs.2018.04.040.
24. Roach RC, Hackett PH, Oelz O, Bärtsch P, Luks AM, MacInnis MJ, et al. The 2018 Lake Louise Acute Mountain Sickness Score. High Alt Med Biol 2018;19:4–6. Doi:10.1089/ham.2017.0164.
25. Davis C, Reno E, Maa E, Roach R. History of Migraine Predicts Headache at High Altitude. High Alt Med Biol 2016;17:300–4. Doi:10.1089/ham.2016.0043.
26. Okuma H, Okuma Y, Kitagawa Y. Examination of fluctuations in atmospheric pressure related to migraine. Springerplus 2015;4:790. Doi:10.1186/s40064-015-1592-4.
27. Karle FJ, Auerbach PS. Migraine Headache Confounding the Diagnosis of Acute Mountain Sickness. Wilderness Environ Med 2014;25:60–8. Doi:10.1016/j.wem.2013.10.006.
28. Ashina S, Mitsikostas DD, Lee MJ, Yamani N, Wang S-J, Messina R, et al. Tension-type headache. Nat Rev Dis Primers 2021;7:24. Doi:10.1038/s41572-021-00257-2.
29. Poussel M, Laroppe J, Hurdiel R, Girard J, Poletti L, Thil C, et al. Sleep Management Strategy and Performance in an Extreme Mountain Ultra-marathon. Research in Sports Medicine 2015;23:330–6. Doi:10.1080/15438627.2015.1040916.
30. Sandoe CH, Kingston W. Exercise Headache: a Review. Curr Neurol Neurosci Rep 2018;18:28. Doi:10.1007/s11910-018-0840-8.
31. Angelini C, Giardini G, Falla M. Travel to altitude with neurological disorders — recommendation of the UIAA Medical Commission. Health Promotion & Physical Activity 2021;15:29–39. Doi:10.5604/01.3001.0015.0506.
32. Davis C, Hackett P. Advances in the Prevention and Treatment of High Altitude Illness. Emergency Medicine Clinics 2017;35. Doi:10.1016/j.emc.2017.01.002.
33. Falla M, Giardini G, Angelini C. Recommendations for traveling to altitude with neurological disorders. J Cent Nerv Syst Dis 2021;13. Doi:10.1177/11795735211053448.
34. Toussaint CM, Kenefick RW, Petrassi FA, Muza SR, Charkoudian N. Altitude, Acute Mountain Sickness, and Acetazolamide: Recommendations for Rapid Ascent. High Alt Med Biol 2021;22:5–13. Doi:10.1089/ham.2019.0123.
35. Zelmanovich R, Pierre K, Felisma P, Cole D, Goldman M, Lucke-Wold B. High Altitude Cerebral Edema: Improving Treatment Options. Biologics 2022;2:81–91. Doi:10.3390/biologics2010007.
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Copyright (c) 2025 Andrea Veronica Marengo, Malena Tejada , María Isabel Cusicanqui Giles , Katherine Natali Ramirez Andia (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
