UCONN Emergency Medicine Interest Group

Posts Tagged ‘headache’

Journal Article Synopsis: Ibuprofen and Acetazolamide as Prophylaxis for High Altitude Headache

In JOURNAL CLUB on May 18, 2011 at 5:50 PM

Summary for “Prospective, Double-Blind, Randomized, Placebo-Controlled Comparison of Acetazolamide Versus Ibuprofen for Prophylaxis Against High Altitude Headache: The Headache Evaluation at Altitude Trial (HEAT) by Jeffery Gertsch, MD, et al. in Wilderness and Environmental Medicine vol 21 pp: 236-243.

What is already known on this topic:
Headaches are one of the most common complaints from those who venture into high altitudes. Termed High Altitude Headaches (HAH), these can occur as benign incidents but are also considered a sentinel symptom of the development of Acute Mountain Sickness (AMS). AMS is defined at altitudes above 2500m with the presence of headache and one other symptom (anorexia, fatigue, insomnia, or dizziness).  Left untreated, AMS can lead to High Altitude Cerebral Edema (HACE) which is associated with a significant mortality rate. Ibuprofen was widely been used in the treatment of HAH through its inhibition of the inflammatory pathway. Acetazolamide, a diuretic and carbonic anhydrase inhibitor, has also been documented in the prevention of altitude headaches. The mechanisms of AMS prevention include renally induced metabolic acidosis resulting in diuresis and increased ventilation and inhibition of CSF production.

What questions this study addressed:
Despite the frequency with which HAH occur, there is a relative lack of literature pertaining to its prevention. This study was designed to compare the effects of treatment with ibuprofen with acetazolamide while also better establishing clinical standards for HAH prevention.

What was the study design:
This study was a prospective, double-blind, randomized, placebo-controlled trial.

What this study adds to our knowledge:
Both ibuprofen and acetazolamide proved effective in the prevention of HAH and can be recommended for prophylaxis at altitude with the inference that acetazolamide may prevent more severe headaches. The clinical efficacy of low-dose acetazolamide in the prevention of AMS has been reconfirmed and ibuprofen was also found to be effective against symptoms of AMS.

How this is relevant to clinical practice:
The use of these drugs in high altitude situations may help lower the incidence of AMS and thus prevent the onset of HACE and decrease the incidence of HACE-related mortality.

Other considerations:
Would other NSAIDs provide the same or similar protection? Is the action of ibuprofen simply masking the pain of a true underlying HAH? The participants were already at a high altitude before they began the study. What then, would be the effect of ibuprofen and acetazolamide on people going from low altitude to high. Are these drugs really preventing HAPE/HACE or are they simply preventing one of the symptoms?

%d bloggers like this: