How to Deal With Headaches While Hiking

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A few years ago, when I woke up on a trek through Nepal, I saw our guide squeezing a friend’s head with both hands as if trying to crush a melon. My friend had woken up with a severe headache, perhaps from the altitude or from a long sunny day in the mountains. Squeezing helped a little – possibly just a distraction from pounding.

Far from home, a nagging headache can bring fear, frustration, or even misery and despair. As a caregiver, headaches also frustrate me. They can mean anything from a minor inconvenience to life-threatening bleeding or brain swelling. The first step to treating a headache has to be to rule out the dangerous substances, and then offer a potentially helpful treatment that might be at hand (although I’m not sure I can vouch for head squeezing).

When should you be concerned? A “thunderclap” headache that reaches its maximum intensity minutes or even seconds after onset can be a sign of a true emergency and requires immediate attention. Severe, ‘worst’ headache ever warrants evacuation to frontland care. Headaches associated with a fever or stiff neck, difficulty speaking, or weakness on one side of the body can also mean problems. I wouldn’t mess with any of these in the backcountry – if you come across one on the trail, evacuate as soon as possible.

Fortunately, less threatening causes like tension headaches and migraines make up the vast majority of headaches. Both are uncomfortable and sometimes unbearable. Many people with migraines have experienced similar symptoms in the past and can tell you if they have a “typical” headache. Fortunately, neither tension headaches nor migraines are generally life-threatening and can be safely treated in the wild (see below).

Changes in routine may predispose some hikers to headaches: travel, lack of sleep, dehydration, and increased stress can all be triggers. Caffeine withdrawal can do it, too—so if you’re used to a couple of double espressos every morning, plan on getting enough caffeine intake on the trail or prepare for a withdrawal headache a day or two after cutting back (thankfully there’s an easy fix here). ).

Hiking at altitude comes with its own set of risks. Altitude headaches often herald the onset of other symptoms of altitude sickness, such as trouble sleeping, dizziness, or nausea. Acclimatization time and anti-inflammatories like ibuprofen can help at altitude, and as always, descending is the best treatment for any type of altitude sickness. Remember the warning signs: An abnormal neurological exam, such as B. Poor coordination (can’t walk, poor balance) can be a sign of life-threatening brain swelling, and it means it’s time to get help. And remember, a headache is an early symptom of carbon monoxide poisoning. Therefore, headaches when cooking in tents, huts, or other confined spaces should sound an alarm, especially if several people develop symptoms.

The treatment requires some personalization. For some, ibuprofen, acetaminophen, or a strong cup of coffee will suffice. Otherwise, rest, staying hydrated, or avoiding bright lights and loud noises may be key. Non-pharmaceutical treatments such as relaxation techniques, biofeedback, and meditation can be great self-rescue strategies. And familiarity with techniques such as acupressure can be a welcome addition to your backcountry medical gear.

On a recent backpacking trip, one of my buddies woke up around midnight with a terrible headache. He looked awful: clammy, sweaty, nauseous. Fortunately, we quickly ruled out some of the causes of the red flag headache: He wasn’t confused or weak, the headaches came on gradually, and he had a history of similar migraine-like symptoms. He stuck it out and with some meds, rehydration and finally some good sleep we were back on track by morning.

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