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This is not a question related to altitude sickness when hiking in very high locations but related to long altitude flights.

When I take an airplane, especially long hauls, I get a terrible headache. It grows little by little, and by the time I reach around 6 hours fly time, it gets very hard to handle, with pain and nausea. Once the plane lands, I am a zombie for some hours and then the pain disappears little by little.

Up to now I haven't found a solution, I just take some ibuprofen pills before the flight and sometimes it works a bit.

I'm not able to sleep on a flight so the problem is even worse.

It's not motion sickness, because I don't have it, and in any case there's not much movement when the plane is in cruise altitude (except for turbulence, but ok), so I'm convinced that it's somehow related to the low pressure that the plane has inside the cabin.

Obviously, no doctor has been able to solve the issue, so I would like to know if anyone out there has/had the same problem and how you solved it.

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    is it possible you are dehydrated? How much do you drink during these flights, and does the headache clear when you get lquid on arrival? Dehydration headaches are very real, I get them, and they are remarkably quick to clear if you drink a big drink of pretty much anything.
    – Kate Gregory
    Commented May 31, 2023 at 17:43
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    no, I drink during flights, and moreover I drink as much as during normal day life. the headache clears after flights even if I don't drink nothing at all. anyway thanks for your feedback!
    – Val
    Commented May 31, 2023 at 19:04
  • Have you read about "Altitude Illness"?
    – Nean Der Thal
    Commented May 31, 2023 at 20:17
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    I'm just looking to other people's feedback on the subject. It's not sinuses because I don't feel any pressure on my face and my nose works as normal. I honestly don't remember if I had the problem when I flew with modern planes, but worths considering. I never landed in a place with lower pressure than the plane, and I don't plan to try :) I only remember that I had the same symptoms when I went up to the top of Marmolada (italy) which is 3k meters high, with funicular railway. the sudden change of altitude, and therefore pressure, produced a terrible headache
    – Val
    Commented Jun 1, 2023 at 6:16
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    @NeanDerThal yes I found some articles about it, and all of them suggest to let the body to acclimate, so a gradual increasing of the altitude, not very easy to achieve with an airplane..
    – Val
    Commented Jun 1, 2023 at 6:19

2 Answers 2

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It seems likely that it is indeed altitude sickness. I asked about sinuses because I have had a couple of instances of dental pain that seem to be related to a sinus, but these were sudden and quick, occurring only during ascent and descent when the pressure was changing. (I also had no nasal congestion in these cases; it's possible for sinuses to be blocked when the nose isn't.)

Cabin pressures have traditionally been the equivalent of an altitude of around 7,000 to 8,000 feet (2,134 m to 2,438 m). Individual susceptibility to altitude sickness varies; most people do not experience it at these elevations, but Wikipedia says that it "occurs in about 20% of people after rapidly going to 2,500 metres (8,000 ft)." Thus, we should expect to see a small but significant proportion of people suffering from altitude sickness on long flights, and you may well be one of these people.

Headache is the primary symptom used to diagnose altitude sickness, especially if it occurs in combination with any of a list of other symptoms including nausea and insomnia, both of which you mention.

A commenter mentions the age of planes, and indeed newer planes are designed to be pressurized to a lower effective altitude. However, the fact that they can support a higher pressure doesn't necessarily mean that they will be pressurized to that pressure on any given flight.

For prevention, Wikipedia mentions ensuring proper hydration (but excessive hydration does not confer any benefit) and avoiding alcohol and sleeping pills. It also suggests avoiding strenuous activity, but that is not of particular concern during a long-haul flight.

Treatments mentioned in the Wikipedia article include

  • oxygen, which is probably impractical,
  • acetazolamide, a prescription medication,
  • ibuprofen at 600 mg three times daily, which is probably more than you've been taking, and
  • acetaminophen (paracetamol)

If your doctor hasn't explored the possibility of altitude sickness in depth, it is probably a good idea to revisit the possibility.

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  • However, the fact that they can support a higher pressure doesn't necessarily mean that they will be pressurized to that pressure on any given flight My understanding is that there is essentially no reason why a 787/A350 would not be pressurised to the lower altitude equivalent, since it is more comfortable for everyone and has no downsides. So OP should try and book flights on these aircraft if possible to see if it helps.
    – MJeffryes
    Commented Jun 1, 2023 at 13:12
  • @MJeffryes are there in fact no downsides? Couldn't lower pressure reduce costs for example in terms of maintenance requirements? I haven't been able to find any information one way or the other.
    – phoog
    Commented Jun 1, 2023 at 13:25
  • @MJeffryes I will for sure note the aircraft type and symptoms next time I will fly. It's unlikely I will choose a flight based on the age of the aircraft, tickets are expensive enough already :)
    – Val
    Commented Jun 1, 2023 at 13:29
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    @Val presumably you'd only need two or three 600 mg doses for a single flight.
    – phoog
    Commented Jun 1, 2023 at 13:39
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    @phoog It seems unlikely to me. The aircraft are designed to be set at the lower altitude. Maintenance is (as I understand it) based on pressurisation cycles, I doubt the maintenance schedule allows them to do maintenance after more cycles if they use lower pressurisation.
    – MJeffryes
    Commented Jun 1, 2023 at 13:55
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If you don't think it's altitude sickness, maybe altitude sickness medication can still alleviate the issue better than just ibuprofen. See if your doctor can prescribe you something like Diamox. If all else fails, I think it's worth a try.

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  • absolutely, I will try different solutions, who knows! thank you
    – Val
    Commented Jun 2, 2023 at 9:03

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