Con: Rebuttal

My opponents (all good friends) devote much of their efforts to emphasizing that headache is common in acute mountain sickness (AMS). But nobody disputes this. The issue is whether headache should be absolutely required for the diagnosis of AMS. In other words, are there instances where people who go to high altitude are incapacitated by various symptoms, but headache does not occur? I believe there is strong evidence to support this, and therefore to absolutely require headache as a symptom inevitably misses some cases of AMS.

Actually, my opponents clearly concede this in their last paragraph. To quote,

We fully agree with the traditional maxim: when feeling bad after a recent gain in altitude (with or without a headache), suspect that altitude is playing a major role until proven otherwise. For practical purposes, anyone with incapacitating symptoms at high altitude, regardless of AMS score or presence of headache, should be treated as if they have severe high altitude illness, descent should be organized and oxygen administered if available.

Exactly. Anyone who develops serious symptoms after a recent gain in altitude (with or without a headache) should be treated by descent if possible, and oxygen should be administered if available. To say that an incapacitating illness after rapid ascent to altitude is not acute mountain sickness simply because there is no headache seems to make no sense. All I am saying is that some people develop an incapacitating sickness without headache after a rapid ascent to altitude that requires treatment, and it is appropriate to refer to this condition as acute mountain sickness.