Avoiding a headache bivying above 3000m/10-11k ft?

I've got a number of summer alpine rock objectives for the year that are made much easier by bivying in the 10-12k elevation range (Mt Alice and the Spearhead in RMNP, Crestone Needle, Full Exum, etc).

However, while I live at around 6k elevation west of Denver, the past times I've tried to camp at those elevations I get a splitting headache that only dissipates after going down to around 8k (usually by abandoning whatever objective). 

Any tips for getting a better night sleep or avoiding a headache after spending a lot of time at altitude? I've done a number of routes+scrambles in the 12k-14k range and never really had issues with headaches, only when trying to sleep.

Ibuprofen 

4-6 hours before altitude and every 4-6 hours after

Stay hydrated also. 

One more tip that's helped me: go as slow as you can on the approach.

I do a fair amount of smash and grabs in the mountains coming from MN. For years it was hit or miss whether Id get bad altitude sickness or no issue at all. For the last couple years, I have been taking Acetazolamide leading up to and during my trips and had zero issue since. Its been great. Lots of CO 12er, 13er, 14ers this way.

Also if youre up for Crestone Needle (assuming you me ellingwood arete), you should add sharkstooth to your list. similar logistics and difficulty/fun

+1 for Acetazolamide (Diamox). I've always struggled with altitude and generally had to use lots of ibuprofen to cope, but I recently got a Diamox prescription. I've only used it once so far but it worked great. 

Get in good aerobic shape, drive up to higher elevation a few days prior to hike or climb and then go back to your house to sleep, then go car camp at 8-9k' between work for a night or two, rest and sleep at your house the last 1-3 nights before the trip. 

+1 water and taking it easy once on the trip. Schedule some extra time and hike up 1k' above your campsite then come back down to sleep can help too. 

Hydration and aspirin.

These headaches are caused by your body pumping out lots of red blood cells in response the the lower oxygen content in the air you are breathing.  This thickens your blood, causing headaches and other symptoms. 

Hydration and aspirin both lessen this thickening effect.  Aspirin in particular is effective because it acts as both a blood thinning and an analgesic agent.  

Kai has it along with slowing down on the approach is your answer.

[ChatGPT]
Great question—yes, ibuprofen has been studied for altitude sickness, and it can help reduce symptoms, but it’s not as effective as acetazolamide (Diamox) for prevention of acute mountain sickness (AMS).

Key Study Evidence: Ibuprofen vs. Diamox
1. NEJM 2012 Study (Richards et al.):
Design: Randomized, placebo-controlled trial.

Participants: 86 healthy adults who ascended to 12,570 ft (3,835 m) in California’s White Mountains.

Treatment: 600 mg ibuprofen taken three times a day, starting 6 hours before ascent.

Results:

AMS incidence was:

43% in placebo group

26% in ibuprofen group

Conclusion: Ibuprofen reduced risk of AMS by about 17 percentage points.

Compared to Acetazolamide:
In multiple studies, acetazolamide reduces AMS incidence by ~50–60%.

A 2017 meta-analysis (Wang et al., High Altitude Medicine & Biology) found:

Acetazolamide: Significantly more effective than placebo and other agents.

Ibuprofen: Helpful, but less effective than acetazolamide.

Summary of Effectiveness
Drug AMS Prevention Effectiveness Onset Key Benefit
Ibuprofen Mild to moderate (~17% risk reduction) Fast Relieves headache, anti-inflammatory
Diamox High (~50–60% risk reduction) 12–24 hrs Accelerates acclimatization physiologically

When to Use Ibuprofen
If you can’t take Diamox (e.g., sulfa allergy).

For mild symptoms or headache relief.

As a supplemental measure during acclimatization.

But for serious prevention, especially if you're going quickly to high altitude (>12,000 ft) or have a history of AMS, acetazolamide is far more reliable.  

MattH, I don't have any answers for you.

So far people have suggested the usual ibuprofen aspirin acetazolamide water-cures-all and weed-cures-all strategies.

A few elements of your original post stand out to me.  A, you have to descend within 2000 feet of your home altitude to resolve debilitating headache.  B, you can tolerate without symptoms 8000 feet of ascent with activity.

That sounds frustrating and restrictive.  A conservative acclimation plan would inch you up the mountains maybe 1000 feet per night.

Some questions: Can you drive to altitude and sleep?  Is the exertion the problem and do you need to slow down and take better care of yourself?  Or is this really a sleep disorder masquerading as an altitude disorder?  Do you have some form of apnea and are you already living at your limit of altitude tolerance?

Best wishes.

As has been mentioned, spend a night beforehand at the trailhead or at a higher no-headache level. Make sure you are hydrated and have good electrolyte replacement. Wear good sunglasses.

If you haven't done so, I'd suggest an altitude challenge test. This is an idea, not some tried and try technique. The intent is to rule out some physiologically fixed altitude trigger/limit. Backpack one of the high peaks, where you can camp at different elevations. Spend a night near, but under, the elevation that triggers the headache. Enjoy nature. The following day, hike higher until you start to develop a headache, camp a bit lower. Maybe repeat. Each day, do some exertional carry with the backpack. Check for other AMS and altitude illness signs and symptoms. Wouldn't hurt to monitor your heart rate and record blood oxygen. Analyze your results.

Alternatively, use the 1,000 ft./day approach.

Perhaps someone has a better strategy?

Thanks everyone for the advice! I've not particularly keen on backpacking and am a weekend warrior so all of my annecdata is from cases where I've driven up/hiked in on day 1, camped (or even stayed in a hotel somewhere like Leadville), got a nasty headache, not slept at all, and given up on the day 2 goal and gone somewhere lower elevation, at which point the headache promptly dissipates. 

I climb a new multipitch route pretty much every weekend of the year (and have plenty of single-day alpine routes on my todo list) so these aren't tightly-held objectives per se but just fun weekend activities, so I've never stuck around to see if things would've stabilized. After a night of zero sleep I'm rarely in the mood to stick around and do some long hike+climb feeling that bad. At some point if these solutions don't work I guess I could try.

I'll have to try these approaches to see if they work out - gradual elevation gain on day 1, extra hydration, and an asprin seems like a good first plan.

Matt Nwrote:

Ibuprofen 

4-6 hours before altitude and every 4-6 hours after

Thanks for the ibuprofen suggestion! I got altitude sickness doing Skywalker Couloir (~13k feet) a few weeks ago, even though I drank many liters of water leading up to the climb. 

Yesterday, I climbed the Sharkstooth in RMNP (~12.5k feet). I took ibuprofen just before hiking the approach, and again when we reached the base of the climb, and I felt incredible the whole day! I also drank many liters of water leading up to the climb, and stayed plenty hydrated throughout the day (the creekwater is delicious). But I was surprised by just how good and strong I felt considering I had experienced altitude sickness at a similar altitude just a few weeks before.

Thanks again for the suggestion!

Duncan Dominguewrote:

Thanks for the ibuprofen suggestion! I got altitude sickness doing Skywalker Couloir (~13k feet) a few weeks ago, even though I drank many liters of water leading up to the climb. 

Yesterday, I climbed the Sharkstooth in RMNP (~12.5k feet). I took ibuprofen just before hiking the approach, and again when we reached the base of the climb, and I felt incredible the whole day! I also drank many liters of water leading up to the climb, and stayed plenty hydrated throughout the day (the creekwater is delicious). But I was surprised by just how good and strong I felt considering I had experienced altitude sickness at a similar altitude just a few weeks before.

Thanks again for the suggestion!

Cheers!
I notice some benefits, but it helps my wife out big time. Coming from sea level, our first day at elevation is always tough, but popping pills makes a noticeable difference.

I seem to do very well at altitude luckily, so the splitting headache is not one ive had to deal with. If I go real high, real quick, a small headache may creep, but baby asprin has been my go to as I it doesnt effect kidneys.
Herb helps me with hunger issues (lack of) at altitude though in a major way, and to get better sleep....I find actual flower to be MUCH more of a medicine than the distillate in pens... I also just like getting high, so medicine and recreational enjoyment wrapped into one!

Pro tip for stoners: solar bowls FTW.... wind cant blow out photons
=)

On a Mera Peak climbing trip ,I used Diamox for the week we were climbing and camping above 16,000 feet so I could sleep and it worked . I was able to sleep at our 19,000 foot camp and had no side effects then or after I stopped .

You live in Denver? Seems like it’d be pretty easy to drive up to keystone/silverthorne (about 9,000 ft) a few nights a week and sleep/back to Denver in the morning for work. Plenty of folks do the opposite commute. If it’s truly an altitude issue you’d get acclimatized real fast and skip all the drugs. Not that i’m anti-drug. 

Hydration for sure. Is there anything obstructing fresh air/oxygen when you sleep? Do you bivy with a bivy closed? Just curious