High Altitude Sickness in Mustang: What Travellers Must Know to Stay Safe

Mustang has a magic that visitors feel the moment they arrive: the open skies, the desert-like cliffs, the sacred trails, and the dramatic views of the Nilgiri and Dhaulagiri ranges. Every year, thousands of Nepali and international travellers head toward Jomsom, Kagbeni, Muktinath and Upper Mustang to experience this unique landscape. But hidden behind this beauty lies a risk many people still ignore — High Altitude Sickness (HAS), also known as Acute Mountain Sickness (AMS).

The altitude in Mustang rises sharply once you leave Tatopani or Ghasa. Jomsom sits at around 2,700 m, Kagbeni at 2,800 m, Muktinath at 3,800 m, and Thorong-La Peak beyond 5,400 m. The air becomes thinner, oxygen levels drop, and the body struggles to adapt. Many travellers underestimate this change, thinking Mustang is “easy” because of the road. But AMS does not care whether you arrived by hiking, jeep, motorbike or plane — the risk remains the same.

This article explains what high-altitude sickness is, why Mustang travellers are especially vulnerable, how to identify symptoms early, what preventive measures to take, which medicines help, and when you must return to lower altitude for safety.

What Exactly Is High Altitude Sickness?

High Altitude Sickness occurs when your body rises to altitude faster than it can adapt to reduced oxygen. Normally, your body needs time to increase breathing rate, adjust blood chemistry, and produce more red blood cells. When you go too high too quickly — which happens frequently in Mustang due to road travel — the body does not get enough time to acclimatize.

The main forms of altitude sickness are:

1. Acute Mountain Sickness (AMS)

The most common, mild-to-moderate form.Symptoms include:

• Persistent headache

• Nausea or vomiting

• Loss of appetite

• Dizziness

• Fatigue, unusual tiredness

• Difficulty sleeping

• Feeling “heavy” or unable to walk normally

If ignored, AMS can progress into life-threatening conditions.

2. High Altitude Pulmonary Edema (HAPE)

Fluid buildup in the lungs — extremely dangerous.Symptoms:

• Shortness of breath even while resting

• Persistent cough, often with frothy or pink sputum

• Chest tightness

• Difficulty walking due to breathlessness

• Blue lips or fingernails

3. High Altitude Cerebral Edema (HACE)

Fluid buildup in the brain — fatal if untreated.Symptoms:

• Confusion

• Loss of coordination (cannot walk straight)

• Severe headache

• Hallucination or abnormal behavior

• Loss of consciousness

Immediate descent and medical support are required. HACE and HAPE kill trekkers every year around the Himalayas, including Mustang routes, often because symptoms were ignored.

Why Mustang Travellers Face Higher Risk

1. Rapid elevation gain

Many travellers go from Pokhara (800 m) to Muktinath (3,800 m) within a day.This is dangerous. Safe ascent limits recommend not sleeping more than 300–500 meters higher than the previous night after 2,500 m.

2. Road makes people overconfident

Because Mustang is accessible by jeep, bus, motorbike and flights, people falsely assume altitude sickness “won’t happen.” In reality, even healthy, fit people can get AMS.

3. Cold and dry climate

Mustang’s wind and dryness cause dehydration, which increases the risk of AMS.

4. Flight to Jomsom

Those who fly to Jomsom reach nearly 2,700 m instantly. Many head straight to Muktinath the same day — a risky jump.

5. Not enough awareness

Most Nepali travellers believe AMS happens only in Everest or Annapurna. But Mustang has dozens of AMS cases every week during peak season.

Common Incidences in Mustang

Over the years, these patterns are frequently seen:

• Travellers reach Muktinath in the afternoon and start feeling sick in the evening or at night.

• People riding motorbikes from Pokhara to Muktinath in one stretch often develop severe headaches and vomiting.

• Elderly pilgrims going for darshan frequently face breathlessness and are unable to walk.

• Riders and jeep travellers push themselves despite symptoms, saying “it will get better”—which often worsens the condition.

• AMS is extremely common during winter (Dec–Feb) because cold reduces oxygen availability and dehydration risk increases.

• Many travellers who spend the night at Kagbeni or Muktinath without acclimatization wake up with severe dizziness.

Awareness is the best prevention.

Preventive Measures — How to Avoid Altitude Sickness

1. Ascend gradually

Ideal Mustang travel plan:

• Day 1: Pokhara → Tatopani/Ghasa (stay the night)

• Day 2: Reach Jomsom or Kagbeni

• Day 3: Visit Muktinath or go higher

Slower = safer.

2. Stay hydrated

Drink 3–4 liters of water per day.Avoid energy drinks, excess coffee, and alcohol (they dehydrate quickly).

3. Eat light, warm meals

Your body digests slower in altitude.

4. Do not ascend with symptoms

If you already have a headache at Jomsom — do NOT go to Muktinath.

5. Walk slowly; avoid running or heavy exertion

Your body needs time to adjust.

6. Wear proper warm clothing

Cold increases AMS risk by constricting blood vessels.

7. Sleep lower if possible

If you visit Muktinath late, sleep in Kagbeni or Jomsom instead of staying at 3,800 m.

8. Avoid alcohol completely

Alcohol + altitude = extremely dangerous.

9. Recognize early warning signs

Headache + nausea = stop immediately and rest.

Medicines You Can Use (Medically Recommended)

1. Acetazolamide (Diamox)

• Helps the body acclimatize faster

• Prevents and treats mild AMS

• Common dose: 125 mg twice daily (start a day before reaching high altitude)

2. Dexamethasone

• Used for severe AMS and HACE

• Use only if medically guided

• It is a life-saving drug but NOT a preventive medicine

3. Nifedipine

• Used for HAPE (lung fluid)

• Only for emergency use under healthcare guidance

4. Painkillers

• Paracetamol or ibuprofen for headaches

• DOES NOT treat the underlying AMS — only symptoms

5. Antacids for nausea

• AMS-related nausea is common

6. Herbal/alternative options

• Garlic soup, ginger tea, and warm fluids help but are supportive, not replacements for medicine.

Never rely only on medication to continue climbing.

When Should You Immediately Return to Lower Altitude?

Descent is the ONLY definite treatment for altitude sickness.

You MUST descend if:

• Headache does not improve after resting

• You vomit more than once

• You feel dizzy while walking

• You cannot sleep due to breathlessness

• Your lips or fingers turn blue

• You feel confused, cannot speak normally

• You have a persistent cough at altitude

• You cannot walk in a straight line

If any of these symptoms appear at Muktinath, Kagbeni or Jomsom, go down by at least 500–1000 m immediately.

Never wait till morning.Never “see if it improves.”AMS can escalate within hours.

How to Stay Safe While Traveling to Mustang

1. Plan your nights carefully

Do NOT jump from Pokhara to 3,800 m in one day.

2. Choose experienced drivers or guides

They recognize danger signs early.

3. Avoid traveling late in the day

Cold + hypoxia at night worsens AMS.

4. Keep your body fuelled

Warm soup, dal-bhat, noodle soup, garlic soup are ideal.

5. Carry essential medicines

Diamox, paracetamol, oral rehydration salts (ORS), and warm clothes.

6. Listen to your body

Your body always warns you before AMS becomes dangerous.

7. Never leave children or older adults unattended

They may develop symptoms silently.

The Final Word: Mustang Is Beautiful — But Respect the Altitude

Mustang is one of Nepal’s most extraordinary landscapes, blending Himalayan culture, high desert valleys, Buddhist heritage, and breathtaking views. But the altitude is real, and the risk is real. Every year, AMS affects travellers simply because they underestimated it.

The good news?Altitude sickness is almost entirely preventable with knowledge, pacing, hydration, and early response.

Travelling to Mustang with awareness means you enjoy the journey safely — whether you’re riding a bike, driving a jeep, flying to Jomsom, or trekking through the ancient trails. High altitude sickness doesn’t have to ruin your trip. Respect the altitude, prepare well, move at a comfortable pace, and listen to your body.

Travel smart. Travel safe. And let Mustang inspire you — without putting your health at risk.

Muktinath Temple (journey to explore )

Jomsom Bazar (wikimedia)