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Barometric Pressure Changes and Health: An Evidence-Based Review

Introduction

Barometric pressure, which varies with weather, altitude, and seasons, has long been observed to impact health, with symptoms often changing alongside atmospheric shifts. As climate patterns evolve and population mobility increases, understanding these effects is crucial. This review summarizes recent research on how changes in barometric pressure affect inflammation, respiratory and digestive health, neurological conditions, pain, autoimmune diseases, and neurodivergent groups. It highlights established findings, gaps in current knowledge, and practical guidance for healthcare professionals.


Inflammation and Joint Pain

General Inflammatory Response to Altitude

At high altitudes, lower air pressure and reduced oxygen activate inflammation pathways in the body through molecules like HIF and NF-κB (Burtscher et al., 2021; Lüdtke et al., 2022). Shortly after arrival, levels of inflammation markers such as HMGB1, TNF-α, IL-1β, IL-6, and IFN-γ increase (Braun et al., 2022; Schagatay et al., 2024), and genes related to these responses become more active (Braun et al., 2021). This initial spike in inflammation subsides after about three days as the body adapts, decreasing its inflammatory signals (Schagatay et al., 2024). Thus, short-term and long-term altitude exposure impact the immune system differently (Du et al., 2022).


Barometric Pressure and Arthritis Pain

Research shows a strong link between barometric pressure and joint pain. Systematic reviews and meta-analyses indicate that lower barometric pressure is associated with more intense pain in osteoarthritis and fibromyalgia patients, with similar patterns seen in animal studies. High-pain days often coincide with below-normal pressure, high humidity, precipitation, and strong winds. The relationship varies among individuals, but barometric pressure consistently stands out as a key factor in weather-related pain (Beukenhorst et al., 2023; Ferreira et al., 2023; Elbers et al., 2020; de Heer et al., 2019; Sugimoto et al., 2025).


Mechanisms Remain Unclear

Despite robust correlational evidence, the precise mechanisms linking barometric pressure to joint pain remain poorly understood. The commonly cited "tissue expansion" hypothesis, suggesting that reduced atmospheric pressure causes soft tissue swelling leading to joint compression, lacks direct experimental support. Alternative proposed mechanisms include:

Mechanism

Description / Reference

Vestibular system activation

Lowering barometric pressure by 40 hPa significantly induces c-Fos expression in the superior vestibular nucleus in mice, suggesting neurological pathways mediate meteoropathy (Kimoto et al., 2019)

Baroreceptor sensitivity

Changes in atmospheric pressure may affect peripheral and central baroreceptors, altering pain perception thresholds

Inflammatory mediator fluctuations

Pressure changes may modulate local inflammatory processes in joint tissues

Psychological expectancy

Weather beliefs and anticipatory anxiety may amplify genuine physiological effects

 

Cold Temperature Effects

Cold weather narrows blood vessels, conserving body heat through mechanisms like TRPA1 channel activation, sympathetic nervous system responses, and reactive oxygen species (Aubdool et al., 2014; Fujii et al., 2017; Yamasoba et al., 2021). However, cold air also triggers inflammation by activating TRPA1 sensors in airway cells, increasing immune response and inflammatory markers such as TSLP, IL-5, and IL-13 (Matsuyama & Kabata, 2025). Studies show that prolonged exposure to cold is associated with higher levels of inflammation markers in older adults (Halonen et al., 2010).


Respiratory Conditions

Asthma and Weather Changes

Although asthma flare-ups linked to weather are well recognized, it's difficult to separate the effects of barometric pressure from other weather factors. Research shows that emergency department visits for asthma rise during weather with low humidity and temperature extremes, rather than just because of changes in barometric pressure (Lim et al., 2016; Tshuma et al., 2021). A systematic review found that cold spells can lead to a 1.25-fold increase in acute asthma attacks requiring emergency care, and a 2.10-fold increase in asthma-related deaths (Xu et al., 2023). Changes in temperature from one day to the next have also been shown to strongly relate to childhood asthma flare-ups in cities (Lv et al., 2020).


Cold Air as Trigger

Exposure to cold air is known to trigger asthma symptoms, and the underlying mechanisms have been elucidated by scientific research. Upon inhalation of cold air, specialized sensors termed TRPA1 channels within the airways are activated, which in turn enhances immune responses, promotes airway inflammation, and elevates levels of specific immune cells and mediators associated with asthma exacerbation (Matsuyama & Kabata, 2025). Additionally, rapid respiration in cold, dry environments, such as during physical activity, can precipitate airway constriction, particularly in individuals with pre-existing airway hyperresponsiveness. This phenomenon, referred to as exercise-induced bronchospasm, is frequently observed among patients with asthma (West, 2009).


Altitude Effects on Respiratory Function

Altitude-induced hypoxia has a negative impact on respiratory function due to diminished partial pressure of oxygen, exposure to cold, dry air, and changes in atmospheric pressure. High-altitude environments pose several documented challenges to pulmonary physiology, as observed in studies at elevation (Peacock, 1998; West, 2004). Additionally, the arid conditions found at altitude decrease mucus fluidity and lead to increased respiratory water loss, thereby exacerbating symptoms in individuals with heightened susceptibility (Peacock, 1998).


Gastrointestinal System

Hypoxia-Induced Intestinal Damage

High altitude reduces air pressure and oxygen, activating molecules such as HIF-1α, NF-κB, and STAT1 that lower proteins vital for intestinal barrier integrity (Ding et al., 2025; Liang et al., 2023; Liu et al., 2022; Yu et al., 2015). Physical activity in these conditions heightens gut injury, as shown by increased markers like I-FABP, claudin-3, and lipopolysaccharide binding protein (da Fonseca-Caetano et al., 2022; Wood et al., 2022). Low oxygen and pressure can also lead to weight loss, altered colon structure, reduced Mucin2 production, and activation of the Notch pathway (Ding et al., 2025). These changes drop colonic oxygen levels and may trigger maladaptive responses (Liu et al., 2022). High altitude increases inflammatory mediators and gene activation related to gut dysfunction. Instead of “leaky gut syndrome,” the scientific terms “increased intestinal permeability” or “intestinal barrier dysfunction” are preferred, with strong evidence linking high altitude to these issues.


Gut Microbiome Changes at High Altitude

Exposure to high altitudes leads to shifts in gut bacteria as the body adjusts to lower oxygen levels, which can influence enzyme activity and immune response (Bisht et al., 2013). These bacterial changes may result in digestive problems such as bloating and diarrhea (Wang et al., 2023). Consuming foods rich in fermentable fibers and polyphenols supports the integrity of the gut barrier and helps prevent “leaky” gut, underlining the importance of gut bacteria for digestive health at altitude (Havenaar et al., 2025). Akkermansia muciniphila is a particularly important bacterium for protecting the gut in low-oxygen conditions (Xia et al., 2023).


Gas Expansion Effects

At high altitudes, lower air pressure causes gases in the body to expand, as stated by Boyle’s law. Studies show this can lead to digestive discomfort from trapped gas, even at moderate elevations (Fothergill et al., 2020). In patients with gas left in the eye after surgery, high altitude can dangerously raise eye pressure (Kokame et al., 2014; Vo et al., 2019). Gut bloating is usually mild since gas can escape naturally.


Appetite and Hydration

Being at high altitude often makes people lose their appetite and become dehydrated more easily. Research shows that reduced appetite is a common symptom of acute mountain sickness, along with nausea and headache (Bärtsch & Swenson, 2013; Cymerman & Rock, 1994). The dry air at altitude causes the body to lose water without noticing, and people may not feel as thirsty, which increases the risk of dehydration. All these factors can make stomach problems worse when at high altitude.


Neurological Effects and Concussion Recovery

Hypoxia and Traumatic Brain Injury

The timing of hypoxia following traumatic brain injury (TBI) critically influences recovery. Early hypobaric hypoxia after TBI heightens neuroinflammation and worsens brain injury (Hu et al., 2015), whereas altitude exposure reveals otherwise hidden cognitive deficits in mild TBI patients (Sinnott et al., 2019). Cognitive function declines with increasing altitude, notably above 15,000 feet, and recovery often lags behind reoxygenation (McMorris et al., 2021). However, controlled intermittent hypoxia can improve neurological outcomes under certain protocols, as shown in rodent stroke models (Gao et al., 2014; Sun et al., 2021), highlighting that hypoxia’s effects depend on timing, duration, and severity.


Barometric Pressure and Cerebral Blood Flow

Although high-altitude cerebral edema (HACE) is associated with changes in cerebral blood flow and effects related to pressure (Ye et al., 2024), there is currently insufficient evidence indicating that barometric pressure fluctuations directly impair cerebral perfusion during concussion recovery. Existing research demonstrates that altitude exposure modifies cerebral blood flow regulation; however, these changes are predominantly attributed to hypoxia rather than direct alterations in barometric pressure (Arce-Álvarez et al., 2025).


Migraines and Headaches

Barometric pressure changes can trigger migraines in some people, but the effects are generally modest and inconsistent. A review of 14 studies (2,696 participants, mostly women) found mixed results regarding pressure fluctuations and migraine characteristics (Waraich et al., 2025). Weather explains about 20% of migraine variability (Wang et al., 2024). Japanese studies link low barometric pressure to headaches, especially in women (odds ratio 2.92; Kikuchi et al., 2024). Results vary by individual, location, and study method (Kimoto et al., 2015; Waraich et al., 2025).


Mechanisms of Pressure-Induced Headache

Researchers have found that shifts in weather, particularly drops in air pressure, can trigger migraines. For instance, a 40 hPa decrease in barometric pressure activates the superior vestibular nucleus in mice, suggesting the vestibular system may contribute to weather-related headaches (Kimoto et al., 2019). This aligns with existing knowledge that changes in pressure affect brain chemicals like serotonin and CGRP, increasing migraine risk (Heshmat Ghahderijani et al., 2021). Additionally, TRPA-1 receptors help sense atmospheric changes and may heighten sensitivity to weather triggers.


Sleep Disruption

Sleep disturbance at altitude is well-documented and affects neurological recovery. Acute mountain sickness includes sleep disruptions as a core symptom, manifesting as periodic breathing patterns, nocturnal hypoxemia, and sympathetic activation (Bärtsch & Swenson, 2013; Cymerman & Rock, 1994). Given sleep's critical role in neurological recovery and memory consolidation, altitude-induced sleep disruption could plausibly impair concussion recovery, though studies specifically examining this relationship are lacking.


Autoimmune Conditions: A Critical Research Gap

Despite comprehensive literature reviews spanning multiple databases, there is a lack of peer-reviewed research directly investigating the influence of barometric pressure on autoimmune disease flares (including systemic lupus erythematosus, rheumatoid arthritis, multiple sclerosis, and inflammatory bowel disease). This absence highlights a significant knowledge gap in the field. Notably, numerous patient-reported experiences suggest a sensitivity to weather conditions. While the relationship between atmospheric pressure and joint pain in osteoarthritis has been well documented, the impact on autoimmune disease activity remains unexamined. Additionally, circadian immune rhythms and their modulation by environmental factors are established phenomena in current scientific literature.


Related Environmental Evidence

While barometric pressure remains uninvestigated, related environmental factors affecting autoimmune conditions provide context:

Factor

Effect

Associated Diseases

Mechanism

References

Air Pollution

Increases odds of psoriasis/eczema, exacerbates autoimmune disease

Psoriasis, eczema, autoimmune disease

Oxidative stress, AHR activation

Dinse et al., 2024; Li & Wang, 2018; Maher et al., 2018; Zhao et al., 2017; Kuo et al., 2022

Climate Change

Increased allergic and autoimmune disease prevalence

Allergic disease, autoimmune disease

Epigenetic modifications in immune cells

Runkle et al., 2023

Stress

Increases autoimmune disease flares in university students

Systemic lupus erythematosus, rheumatoid arthritis, fibromyalgia

Examination stress

Hadjadj et al., 2020

Circadian Disruption

Sleep disturbances implicated in autoimmune disease pathophysiology

Systemic lupus erythematosus, rheumatoid arthritis, inflammatory myositis

Altered circadian rhythms

Hao et al., 2023

 

Arthritis Pain Evidence

The strongest barometric pressure evidence concerns osteoarthritis pain rather than autoimmune arthritis. The systematic review and meta-analysis previously cited (Beukenhorst et al., 2023; Ferreira et al., 2023) provides robust evidence for pressure-pain correlations in osteoarthritis, but whether similar mechanisms operate in rheumatoid arthritis or other autoimmune joint diseases remain unknown.


Neurodivergent Populations: Lack of Existing Research

There is currently no peer-reviewed research on how barometric pressure affects symptoms of attention-deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD). This lack of research is notable, especially since individuals with these conditions often experience increased sensory sensitivity, strong reactions to their environment, and autonomic nervous system irregularities.


Autism Spectrum Disorder and Environmental Sensitivity

Many autistic individuals experience stronger reactions to sensory inputs compared to neurotypical people (Bitsika et al., 2024; Cullen et al., 2024). Studies have found that increased sensitivity to sensory stimuli, observed in both autistic and non-autistic people, is linked to less gamma response suppression in the visual cortex (Frey et al., 2021; van Leeuwen et al., 2019). People with ASD often notice subtle sounds easily and may have trouble understanding emotional nuances in speech (Larsen et al., 2022). Environmental factors like season changes and climate events can influence ASD symptoms and behaviors, especially among children with significant intellectual disabilities (Kotozaki & Watanabe, 2024; Ozcan, 2024; Sarovic & Lai, 2023). A preference for routine and sensitivity to sudden environmental shifts are also common among autistic individuals (Lawson et al., 2017). Additionally, early exposure to air pollution (PM2.5) may make sensory-related ASD symptoms more severe (Yu et al., 2025).


ADHD and Environmental Factors

Individuals with ADHD frequently exhibit variations in physiological responses to stress and arousal, potentially resulting in observable physical symptoms (Vainieri et al., 2024). For instance, research assessing heart rate has shown that autistic children tend to display increased alertness during activities, whereas children with ADHD demonstrate distinct patterns (Nikula et al., 2021). Adolescents diagnosed with ADHD also present higher concentrations of specific inflammatory markers in their blood (IL-1β, IL-6, TNF-α) and an elevated presence of M1 macrophages relative to non-ADHD peers. These findings indicate that their immune systems may be more susceptible to environmental influences (Levantini et al., 2023).


Co-occurrence and Implications

Thirty-one percent of children with ASD also meet criteria for ADHD, and 24% show subthreshold symptoms (Antshel et al., 2009; Mayes et al., 2024; Sadeghi Bahmani et al., 2023), reflecting notable psychosocial challenges. ADHD and autism are associated with altered sensory processing, often linked to anxiety and variable responses to stimuli (Ghanizadeh et al., 2023). Air pollution, especially particulate matter, is tied to higher ADHD risk (de Keijzer et al., 2019). The combination of sensory sensitivity, autonomic changes, inflammation, environmental reactivity, and a need for predictability in neurodivergent groups may theoretically support barometric pressure sensitivity, although this is unstudied. Anecdotal evidence suggests weather shifts can trigger headaches, anxiety, sleep disturbances, and sensory overload, indicating systematic research is needed.


Clinical Insights and Guidance

For Healthcare Providers

Suggestion

Details

Acknowledge Patient Reports

Weather sensitivity is real for some individuals, particularly those with migraines, osteoarthritis, and fibromyalgia. Dismissing patient reports as placebo effects undermines therapeutic relationships.

Consider Environmental Factors

Comprehensive symptom management should include environmental factors in differential diagnosis and treatment planning.

Encourage Personal Tracking

Recommend symptom-weather correlation tracking using mobile applications or diaries to identify individual patterns.

Avoid Over-Attribution

Without documented correlation in individual patients, avoid definitively attributing symptoms to weather changes.

Recognize Individual Variability

Weather sensitivity demonstrates substantial inter-individual variation. Universal recommendations are inappropriate.

Altitude Travel Counseling

For patients with concussion history, respiratory conditions, or gastrointestinal disorders, provide pre-travel counseling regarding altitude-related risks and symptom management strategies.

 

For Patients

Key Point

Details

Weather Sensitivity Varies

Effect sizes are modest (approximately 20% for migraine), many individuals show no correlation

Multiple Factors Contribute

Barometric pressure, temperature, humidity, sleep quality, stress, medication adherence influence symptoms

Personal Tracking Recommended

Individual symptom-weather pattern tracking can identify personal vulnerabilities, enable anticipatory management

Evidence-Based Strategies

Consult healthcare providers for evidence-based prevention and treatment strategies, not relying solely on weather-avoidance

 

For Researchers

Key research priorities:

Research Area

Description

Neurodivergent Population Research

Systematic examination of pressure sensitivity in ADHD and autism populations using objective physiological measures.

Mechanistic Studies

Investigations of vestibular, autonomic, and inflammatory pathway involvement in pressure-related symptoms.

Individual Variability Profiling

Identification of genetic, physiological, or psychological factors predicting weather sensitivity.

Longitudinal Mobile Health Studies

Large-scale studies using smartphone applications and wearable sensors for real-time symptom-weather correlation.

Controlled Chamber Experiments

Laboratory studies isolating barometric pressure from confounding weather variables.

 

Limitations and Methodological Challenges

Several methodological challenges complicate weather-health research:

Issue

Description

Confounding Variables

Barometric pressure rarely changes in isolation. Temperature, humidity, precipitation, and wind speed co-vary, making causal attribution difficult.

Retrospective Bias

Symptom recall in retrospective studies may be influenced by weather beliefs and expectations.

Small Effect Sizes

Weather typically explains 10-20% of symptom variance, requiring large samples for adequate statistical power.

Publication Bias

Studies finding no association may be under-represented in published literature.

Individual Differences

Substantial inter-individual variability suggests subgroup analyses are necessary but often underpowered.

Temporal Dynamics

Acute versus chronic exposure effects differ, yet many studies lack longitudinal designs.

 

Conclusion

Research shows that barometric pressure influences some health conditions, such as osteoarthritis pain and migraines, though effects are generally modest and vary from person to person. Altitude-related hypoxia affects inflammation, respiration, and neurological recovery, but there is little research on how pressure changes impact autoimmune disease flares and neurodivergent populations. The lack of studies does not mean no effect exists; rather, these areas remain unexplored. Given these groups' sensitivity to environmental changes, more systematic research is needed. As climate and mobility shift, understanding these impacts becomes vital. Future studies should use objective measures, personalized approaches, and collaboration across disciplines to better identify vulnerable populations and develop effective interventions.


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