Intracranial Pressure at Altitude

Rapid ascent to high altitude can result in high altitude headache, acute mountain sickness, and less commonly, high altitude cerebral or pulmonary edema. The exact mechanisms by which these clinical syndromes develop remain to be fully elucidated. Direct and indirect measures of intracranial pressure (ICP) usually demonstrate a rise in pressure when human subjects and animals are exposed to acute hypoxia. However, the correlation of ICP changes to symptoms and altitude-related illnesses has been difficult to establish. Headache, for example, may occur with vessel distension prior to a rise in ICP. This article reviews the literature both supporting and refuting an increase in ICP as the underlying mechanism of headaches and other related neurological sequelae experienced at high altitude.