Management of AMS
Prospective, Double-Blind, Randomized, Placebo-Controlled Comparison of Acetazolamide Versus Ibuprofen for Prophylaxis Against High Altitude Headache: The Headache Evaluation at Altitude Trial (HEAT)
High altitude headache (HAH) is the most common neurological complaint at altitude and the defining component of acute mountain sickness (AMS). However, there is a paucity of literature concerning its prevention. The researchers sought to compare the effectiveness of ibuprofen and acetazolamide for the prevention of HAH.
Three hundred forty-three healthy western trekkers were recruited at altitudes of 4280 m and 4358 m and assigned to receive ibuprofen 600 mg, acetazolamide 85 mg, or placebo 3 times daily before continued ascent to 4928 m. Outcome measures included headache incidence and severity, AMS incidence and severity on the Lake Louise AMS Questionnaire (LLQ), and visual analog scale (VAS).
Two hundred sixty-five of 343 subjects completed the trial. HAH incidence was similar when treated with acetazolamide (27.1%) or ibuprofen (27.5%; P = .95), and both agents were significantly more effective than placebo (45.3%; P = .01). AMS incidence was similar when treated with acetazolamide (18.8%) or ibuprofen (13.7%; P = .34), and both agents were significantly more effective than placebo (28.6%; P = .03). In fully compliant participants, moderate or severe headache incidence was similar when treated with acetazolamide (3.8%) or ibuprofen (4.7%; P = .79), and both agents were significantly more effective than placebo (13.5%; P = .03).
Fascinatingly the authors demonstrated that Ibuprofen and acetazolamide are similarly effective in preventing HAH. This adds another medication to the useful arsenal to use in the treatment of AMS and in particular is especially useful when you have a patient who can’t take acetazolamide (diabetics or sulphur allergies) .
Learn more about Altitude Medicine by joining Expedition and Wilderness Medicine’s CME accredited Mountain Medicine course in Nepal headed up by Everest ER founder Dr Luanne Freer
Nick Arding will be joining Expedition Medicines Mountain Medicine course on the Everest Base Camp Trail along with Dr’s Luanne Freer of Everest ER and Amy Hughes of Kent HEM’s service in October on what promises to be an amazing CME accredited course*.
Nick served as an officer in the Royal Marines for 22 years, travelling and climbing widely during that time. In ‘92 he took part in the British Annapurna 2 Expedition and in ‘93 led his own trip to climb the West Buttress of Mt McKinley in Alaska. He commanded the Commando Training Centre Royal Marines from 2003 to 2005.
In 2003 Nick led a Royal Navy expedition to climb Everest by its North Ridge; not only did they climb the mountain but his team were instrumental in rescuing two other climbers from above 8000m, the highest mountain rescue on record and for which he was awarded the Royal Humane Society Bronze Medal.
A keen rock climber and mountaineer since his teens, Nick holds the Mountaineering Instructor (MI) and International Mountain Leader (MIA) awards.He left the Royal Marines in 2005 to qualify as a teacher and now works as a leadership coach and management consultant. He has led civilian teams to Mongolia, Nepal and the Alps, and when not working can usually be found on a rock face or in a sea kayak! In 2009 Nick took a team of friends to the Rolwaling Valley in Nepal to attempt an unclimbed mountain called Cheki-go. He has close links with this region, having raised funds to sponsor local Sherpas, three of whom have been able to visit the UK to improve their climbing skills and English language.
*accredited by the Wilderness Medical Society