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Background: High-altitude headache (HAH) is a hypobaric hypoxia-induced symptom that is commonly experienced by newcomers to high-altitude areas., Objective: To assess the efficacy of gabapentin in the prevention of HAH., Methods: A placebo-controlled randomised trial was performed at an altitude of 3500 m. Two hundred and four unacclimatised 15-65-year-old (mean age (+/-SD), 31.5 (SD 11.7)) hotel guests were randomly assigned to a 600 mg single-dose of gabapentin capsule or identical placebo. HAH incidence and intensity were measured to assess gabapentin efficacy. Intention-to-treat analysis was performed., Results: HAH incidence was not significantly different between subjects under gabapentin (44 (43.1%)) compared with placebo (56 (54.9%); p = 0.09). In contrast, moderate/severe HAH had a lower incidence in the gabapentin group (27 (26.5%)) versus the placebo group (42 (41.2%)), showing that gabapentin reduced HAH attack intensity (p = 0.03)., Conclusions: Gabapentin was effective for the prevention of HAH and had satisfactory tolerability., Trial Registration Number: ISRCTN26123577.

Headache is the most prevalent symptom of acute mountain sickness. We conducted a pilot clinical trial at an altitude of 3500 m to evaluate the efficacy of gabapentin in treatment of high-altitude headache (HAH). Twenty-four adult HAH patients (10 female, 14 male; age 18-50 years) were randomly assigned to receive either 300 mg of gabapentin capsule or identical placebo. After 1 h the presence of HAH and need to receive supplementary analgesic were assessed. The duration of the HAH-free phase after taking additional analgesic was also registered. Four patients in the gabapentin group asked for additional analgesics, whereas nine placebo recipients did not find primary medication satisfactory after the first hour of treatment (P = 0.04). The mean HAH-free period was 17.10 h in the gabapentin group, which was significantly higher than in the placebo group with a mean of 10.08 h (P = 0.02). This preliminary observation indicates that gabapentin is effective in treatment and alleviation of HAH.

No evidence is available to show that nasal congestion is a manifestation of exposing an individual to high altitude and hypoxia. Since both nasal congestion and high-altitude headache are vasogenic, we explored whether there is a coincidence between these two symptoms. A prospective observational study was carried out on a cohort of 118 adults (>18 years old) in a mountain clinic at 3450 m. After 24 h of ascent, an interview was held to ask if each individual experienced acute mountain sickness symptoms (headache, etc.) and nasal congestion. Sixty-six (55.9%) individuals mentioned headache within 24 h after ascent and nasal congestion was reported by 34 (28.8%) individuals. There was a reverse association between headache and nasal congestion (P < 0.001). In conclusion, there is a reverse association between altitude headache and nasal congestion, probably as result of contradictory autoregulation effects or exaggerated sympathetic activity.