Altitude Headache Not Going Away in Leh: What to Do

This article is for general information only. It is not medical advice. If your symptoms are severe, worsening, or accompanied by neurological signs — confusion, loss of coordination, extreme fatigue — descend immediately and seek medical care.

You landed in Leh. The headache arrived — dull, persistent, usually at the back of the skull or around the temples. You drank water, rested, waited. Twelve hours later it is still there. This is common. The question is whether what you have is ordinary altitude headache that takes longer to resolve for some people, or a sign of something that needs more active management.

The distinction matters. Most altitude headaches at Leh's elevation (3,524m) are uncomfortable but not dangerous. A smaller number are warning signs of acute mountain sickness developing beyond the mild stage. Knowing which you have determines what to do.

Why the Headache Happens

At altitude, the reduced partial pressure of oxygen triggers a mild hypoxic response. One of its effects is cerebral vasodilation — blood vessels in the brain widen slightly as the body attempts to increase oxygen delivery. This increased blood flow, combined with fluid shifts at altitude, raises intracranial pressure. The result is a dull, throbbing headache that typically worsens with exertion, bending forward, or after sleep.

The full explanation of altitude headache mechanism and first-line remedies covers the physiology in detail. The short version: rest, hydration, and time resolve most altitude headaches. But "most" is not "all," and understanding when your headache falls outside the normal range is the useful skill.

What Is Normal — and How Long It Can Last

An altitude headache that develops within six to twelve hours of arriving at Leh, then gradually eases over twenty-four to forty-eight hours with rest and hydration — that is the standard pattern. It is not a sign of a serious problem. It is your body adapting to a new oxygen environment.

The duration varies considerably between individuals. Some people feel better within a day. Others carry a mild headache for two to three days before it clears completely. This is still within normal range at Leh's altitude, provided the headache is not worsening and is not accompanied by other symptoms.

What is not normal: a headache that worsens progressively over twenty-four hours rather than staying stable or improving. A headache accompanied by vomiting, not just mild nausea. A headache that is severe enough to prevent sleep or movement. These patterns require attention — not panic, but active assessment.

Step 1: Check for AMS Progression

Acute mountain sickness is diagnosed using the Lake Louise Score — a simple symptom checklist. You need a headache plus at least one of the following, at moderate to severe intensity, to qualify as AMS:

• Fatigue or weakness (beyond what you would expect from travel)
• Dizziness or lightheadedness
• Nausea or loss of appetite
• Difficulty sleeping

Mild AMS — headache plus one or two mild symptoms — is managed by staying at the same altitude, resting, and not ascending further until symptoms resolve. You do not need to descend from Leh for mild AMS; you need to stop, rest, and let your body catch up.

Moderate to severe AMS — symptoms worsening over twelve to twenty-four hours despite rest, or severe headache not responding to medication — calls for a different response. The AMS symptoms and severity guide covers the full spectrum.

Step 2: What Actually Helps the Headache

Hydration

Dehydration and altitude headache are closely linked — altitude causes increased respiratory water loss and a mild diuretic effect. At Leh, aim for three to four litres of fluid per day. Urine colour is the simplest guide: pale yellow is adequate, dark yellow is not. Oral rehydration salts (available at any pharmacy in Leh) help restore electrolyte balance if you have been sweating or if nausea has reduced your intake.

Medication

Paracetamol (acetaminophen) and ibuprofen both reduce altitude headache effectively. Ibuprofen has some evidence of superior efficacy specifically for altitude headache, but both are appropriate. Standard doses apply. Do not exceed recommended dosing in the hope of clearing the headache faster. If the headache is unresponsive to two doses of either medication taken as directed, that is a signal to reassess rather than to increase the dose.

Rest and Altitude Hold

The cardinal rule: do not ascend while you have a headache. This is not caution — it is the mechanism. Going higher while your body has not adapted to the current altitude accelerates the problem. "Sleep low" means sleeping at Leh's altitude, not at higher camps or villages. Even short drives to higher elevation sites should wait until you have been headache-free for at least a day.

Diamox

Acetazolamide (Diamox) accelerates acclimatization by stimulating deeper breathing, which raises blood oxygen saturation. It is typically taken preventively, not after a headache has developed — but it can help move the acclimatization process forward when rest alone is insufficient. The full Diamox guide covers dosing, side effects, and when to use it. If you are considering Diamox mid-trip for a persistent headache, get advice from a doctor in Leh — several clinics in Leh town see altitude patients routinely and can advise on your specific situation.

Step 3: When to Descend

Most headaches at Leh altitude do not require descent. The elevation is relatively modest, and the town has medical facilities. Descent becomes necessary when:

• Symptoms are worsening over twelve to twenty-four hours of rest at the same altitude
• Neurological symptoms appear — confusion, difficulty walking a straight line, severe fatigue out of proportion to the situation, slurred speech
• Breathing difficulty develops at rest
• The headache is accompanied by coughing with pink or frothy sputum

The last two are warning signs of HAPE and HACE — the serious altitude complications that are medical emergencies. See the HAPE and HACE emergency guide for full detail. These conditions are rare at Leh's altitude, but they are not impossible, particularly in travellers who push through early warning signs.

What Makes Some People More Susceptible

Altitude headache severity is not well predicted by fitness. Physically fit travellers get severe altitude headaches; sedentary travellers sometimes sail through without one. The main predictors are previous altitude experience (prior acclimatization history), rate of ascent, and individual physiological variation — including genetic factors in hypoxic ventilatory response that are not currently easy to measure in advance.

Age, sex, and baseline fitness are poor predictors. There is no reliable way to know in advance how you will respond to altitude. This is why the two-day acclimatization protocol in Leh is standard — it builds a buffer into the trip for exactly the variation in individual response that cannot be predicted.

A Note on SpO2 and Pulse Oximeters

Monitoring blood oxygen saturation (SpO2) with a pulse oximeter is useful context during a headache. Normal SpO2 in Leh for acclimatized travellers is roughly 88–95%; fresh arrivals often read lower. A reading below 80% at rest in Leh warrants medical attention. Readings between 85–90% with a mild headache, improving over hours, are within the expected range for day one.

The oximeter reading is one data point — not a diagnosis. Combine it with how you feel, what other symptoms you have, and whether your condition is improving or worsening over time. A falling SpO2 over several hours, especially combined with worsening symptoms, is more significant than a single low reading taken shortly after landing.