Common above 2,500m and usually mild. The two dangerous forms kill quickly, and going down is the only thing that reliably works.
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Altitude sickness happens when you climb higher than your body has had time to adjust to. It becomes common above about 2,500 metres, and it has very little to do with fitness — young, strong, fit people get it as readily as anyone else, and sometimes more, because they ascend faster.
Most of it is mild: a headache, nausea, poor sleep, feeling wrung out. It settles if you stop and let your body catch up.
Two forms are not mild, and both kill. Fluid on the lungs and swelling of the brain can develop within hours, and people have died on trekking routes and ski trips because the early signs were put down to tiredness or a hangover.
The single thing to take from this page: descent is the treatment. Not medication, not oxygen, not resting a bit higher up. Going down. Everything else buys time to go down more safely.
And never ascend with symptoms. That is the rule that prevents almost all altitude deaths, and it is the one most often broken — usually because a trip has been paid for and a schedule has been set.
Headache is required for the diagnosis, developing 6 to 12 hours after arriving at altitude, plus at least one of:
It feels remarkably like a hangover, which is exactly why it gets dismissed on ski trips.
Ask them to walk heel-to-toe along a straight line. If they cannot, treat it as cerebral oedema and start descending immediately. It takes thirty seconds and it has saved lives.
Being fit. There is no relationship between fitness and susceptibility, and fit people often ascend faster, which increases risk.
Being young. If anything, younger travellers are over-represented, largely for the same reason.
Having been fine at altitude before. It varies between trips.
Altitude sickness is diagnosed on symptoms in the context of recent ascent. The Lake Louise score — headache plus gastrointestinal upset, fatigue, and dizziness, each scored for severity — is the standard tool and is simple enough to use in the field.
The working rule for travellers is blunter and better: any illness at altitude is altitude sickness until proven otherwise. Assuming it is a hangover, a virus or exhaustion is how people die.
Chest X-ray for pulmonary oedema, CT or MRI where cerebral oedema is suspected, and blood tests to exclude other causes — though treatment starts before any of it.
Dehydration, exhaustion, hypothermia, carbon monoxide poisoning from a stove or heater in an unventilated tent or room, migraine, an ordinary viral illness, or low blood sugar.
Carbon monoxide is worth naming — headache and nausea in a group sharing a poorly ventilated shelter with a stove is a recognised and repeatedly missed cause.
If you are at altitude with symptoms now, this is not a page to read — descend and get local help. No remote consultation can assess or treat someone who is acutely unwell on a mountain.
Assessment following an episode, particularly if it was severe or unexpected, and advice on whether and how to travel high again.
Descend at least 500 to 1,000 metres, and keep going until symptoms improve. Someone with these signs must never descend alone, and must never be left alone.
Breathlessness, cough or exercise limitation persists after returning to low altitude, or if you had a severe episode and want to understand whether an underlying heart or lung problem contributed.
It speeds acclimatisation and reduces the chance of acute mountain sickness. It is worth considering where rapid ascent cannot be avoided or where you have had altitude sickness before.
It is not a substitute for sensible ascent, and it does not make it safe to keep climbing with symptoms. Expect tingling in the fingers and toes, more frequent urination, and fizzy drinks tasting strange — all harmless and all normal.
Coca tea, garlic, ginkgo and "altitude" supplements. None has convincing evidence. Bottled oxygen in tourist areas helps briefly and does nothing lasting — and it can mask symptoms that should be prompting descent.
Many standard policies exclude trekking above a stated altitude, often 2,500 or 3,000 metres, and helicopter evacuation from a mountain is extraordinarily expensive. Check the altitude limit specifically rather than assuming you are covered.
This page follows Wilderness Medical Society practice guidelines for the prevention and treatment of acute altitude illness, alongside NICE Clinical Knowledge Summaries and NaTHNaC / TravelHealthPro altitude guidance.
Physical fitness does not protect against altitude illness, and fitter travellers may be at greater risk through faster ascent. Prior successful ascent does not guarantee freedom from symptoms on a later trip.
Reviewed against Wilderness Medical Society, NICE CKS and NaTHNaC guidance current at the date shown above.
No — there is no relationship between fitness and altitude sickness.
Fit people are sometimes at greater risk, because they climb faster and their bodies get less time to adjust.
Going down. Descent is the treatment for every form of altitude illness.
Drugs and oxygen buy time to descend more safely — they do not replace descending.
Often you cannot, which is exactly the danger. On a ski trip or after a night out at altitude, assume it is altitude sickness rather than the drink.
Treat it as altitude illness until it settles.
Ask the person to walk heel-to-toe along a straight line. If they cannot, treat it as cerebral oedema and descend immediately.
It takes thirty seconds and it is the single most useful check on the mountain.
Worth considering if you are ascending rapidly, flying into a high airport, or have had altitude sickness before.
It is not a licence to climb faster, and it does not make ascending with symptoms safe.
No. Nor do garlic, ginkgo or the various altitude supplements sold to trekkers.
Ascending slowly is what works, and nothing sold in a shop substitutes for it.
No, and this is a genuinely dangerous approach. Bottled oxygen relieves symptoms briefly while the underlying problem continues.
It can mask exactly the signs that should be telling you to go down.
Usually above 2,500 metres, and it becomes common above 3,000.
What matters most is the altitude you sleep at, and how fast you got there.
Check the altitude limit specifically. Many policies exclude trekking above 2,500 or 3,000 metres.
Mountain helicopter evacuation is extremely expensive, and finding out afterwards is a poor time to discover an exclusion.
August 30, 2026
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