Altitude Sickness in the Northern Areas: Prevention

Altitude sickness in the Northern Areas is a real risk on a short list of specific places, not a general worry for the whole trip. Karimabad, Gilgit and Skardu sit between about 1,500 and 2,300 metres, low enough that almost nobody feels more than mild breathlessness. The risk starts on the day trips and treks that go well above 3,000 metres in hours rather than days: Khunjerab Pass, Deosai, Babusar Top, Shandur, Fairy Meadows and the high lakes of Azad Kashmir such as Ratti Gali and Shounter.

This guide sets out which places carry the risk, what altitude sickness feels like, how to plan a trip so you acclimatise rather than just arrive, what Diamox does and doesn't do, and when the answer is simply to go down.

Where altitude actually becomes a risk

The valley floors of the north are not high enough on their own to trouble most travellers. What changes things is a fast climb: a day trip or an overnight that takes you 1,500 metres or more above where you slept the night before, in a car or on foot rather than over several days.

That is exactly the shape of the popular high-altitude outings:

• Khunjerab Pass, more than 2,000 metres above Karimabad, reached in a few hours by road.
• Deosai, roughly 2,000 metres above Skardu, about two hours by jeep.
• Fairy Meadows, where visitors often sleep at 3,300 metres the night after sleeping in Chilas at around 1,265 metres.
• Ratti Gali and Shounter in the Neelum valley, both reached from a valley floor well under 2,000 metres.
• Trekking routes such as K2 base camp or Rupal valley, which put you above 4,000 metres for several nights running.

What altitude sickness feels like

Acute mountain sickness (AMS) is the common, mild form, and it is not dangerous by itself as long as you stop climbing. It typically sets in within a few hours of reaching altitude, often worse the first night.

The main symptom is a headache, usually with one or more of:

• nausea or loss of appetite
• dizziness or a light-headed feeling
• unusual fatigue
• disturbed sleep

Left alone, without going any higher, it normally settles within a day or two.

Two rarer forms are medical emergencies. High-altitude cerebral oedema (HACE) shows as confusion, poor coordination and extreme drowsiness. High-altitude pulmonary oedema (HAPE) starts with breathlessness and a cough that don't fit the exertion, worsening to breathlessness at rest. Either one means descending immediately and getting medical help, not waiting to see if it passes.

In young children who cannot describe a headache, watch instead for fussiness, poor feeding and a pale or grey look.

Who is more at risk, and what raises it

Altitude sickness has little to do with fitness. Fit adults who climb fast are just as likely to get it as anyone else, and sometimes more likely, because they can outpace their own acclimatisation.

The clearest risk factors are:

• having had it before, on a previous trip
• gaining height quickly, especially sleeping at a new, higher altitude on the first night
• pushing hard physically in the first day or two at height

People with coronary heart disease, chronic lung disease or sleep apnoea should discuss any trip above 3,000 metres with a doctor beforehand, and pregnant women are generally advised not to sleep above about 3,000 metres. This is a conversation to have before you book, not a decision to make at a checkpoint.

Acclimatising on a normal Northern Areas trip

The standard rule used by mountain medicine bodies is: once above 3,000 metres, don't raise the height you sleep at by more than 500 metres in a day, and add a rest day for roughly every 1,000 metres beyond that. Two or three nights around 2,400–2,700 metres before going higher also helps a lot, and Hunza and Skardu both sit conveniently in that range.

In practice:

1. Spend at least one or two nights in Karimabad, Gulmit or Skardu before a high day trip. Flying or driving in and heading straight up the next morning is the most common mistake.
2. Take it slowly on the first day at height. No rushing up slopes for photographs, and drink water steadily rather than in bursts.
3. Keep the very high stops short. An hour at Khunjerab and a few hours on Deosai are plenty; there is little to gain by lingering.
4. At Fairy Meadows, make the first evening a quiet one. Save the walk to Beyal or the viewpoints for the second day.
5. Avoid alcohol and hard exercise for the first day or two above 3,000 metres.
6. On a multi-day trek, follow a proper ascent schedule with rest days built in, rather than the fastest itinerary you can find.

Our Skardu and Deosai and Gilgit, Hunza and Khunjerab tours are both built with a night in the valley before the high day out, for this reason.

Diamox and other medicines

Acetazolamide, sold as Diamox, speeds up the body's natural acclimatisation and can reduce the chance and severity of AMS. The typical preventive dose used in mountain medicine is 125 mg every 12 hours, started the day before ascent and continued for the first couple of days at altitude, though the right dose and timing depend on the individual. It is a prescription medicine with side effects such as tingling in the fingers and a change in how carbonated drinks taste, and it is not right for everyone, including some people with sulfa allergies.

Ask your doctor before the trip, not a pharmacist in Gilgit on the way up. For anyone heading to genuinely high, multi-day trekking altitude, it is also worth asking about dexamethasone, which is carried for emergency treatment rather than daily prevention.

For an ordinary first-day headache, paracetamol or ibuprofen usually helps. No tablet makes it safe to keep climbing while you have symptoms.

When to turn round and go down

These rules apply everywhere in the region, at any height:

• Never move higher to sleep while you still have symptoms, however mild they seem.
• If symptoms get worse despite rest, descend. On a road trip that usually just means driving back down to the valley.
• Going down 300 metres or more usually brings quick relief.
• Confusion, staggering or breathlessness at rest mean descending immediately and seeking medical help, not waiting until morning.

On Khunjerab or Deosai this is simple: get back in the vehicle. At Fairy Meadows it means walking or being carried down to Tato and taking the jeep to Raikot Bridge. Don't let a paid-for night or a group schedule keep someone sick at height.

Who should think twice

Most healthy adults and older children manage the popular high-altitude stops without trouble, provided the trip is paced sensibly. Think harder if you are travelling with a baby, with an older parent who tires easily, or with anyone who has heart or lung disease.

For those groups, reasonable substitutes exist: Passu and the Hussaini bridge instead of the full drive to Khunjerab, Sadpara Lake instead of crossing all of Deosai, or a stop at Shogran or Lulusar rather than pushing on to Babusar Top. Our travel guide has more on planning a trip around altitude and weather.

Frequently asked questions