Google “screaming barfies” and you’ll find a confusing selection of blog reports, questionable wiki definitions, and dozens of video clips of climbers on the verge of crying (next to a giggling cameraman). The symptoms are familiar to any ice climber: intense, often scream-inducing pain in the hands, nausea, and the occasional “man tear.” But for such a common ailment, the misinformation and paucity of research available is staggering.

The underlying cause of this problem is tissue ischemia, meaning diminished blood flow to the muscles and soft tissues. This mechanism is most similar to the action of a tourniquet stopping major bleeding, unlike frostbite, which is actual freezing of the tissues and thrombosis (clotting) of the small blood vessels. Ice climbing presents the perfect cocktail of contributing causes. Cold exposure triggers peripheral blood vessels to constrict and shunt blood to the core to prevent hypothermia. Swinging and hanging from ice tools keeps your arms and hands above your heart, which further limits circulation, as does the over-gripping of technical tools. Tight gloves and tool leashes can mechanically constrict blood vessels in the wrists, also reducing the flow of blood and thus oxygen to the hands.

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Typically, it’s when the climber lowers his arms that the hallmark intense pain and nausea set in. When blood flow to the hands is interrupted, the resulting nonfunctional nerves create the sensation of numbness. The subsequent pain is associated with reperfusion (return of blood flow) to the hands and nerves. Upon reoxygenation of these nerves, pain signals are transmitted to the central nervous system. In other words, when the blood returns, it re-awakens the nerve endings, and hurts like mad.

Wear gloves that have adequate insulation for the current temperature, yet thin enough to provide adequate tool grip and foster unrestricted circulation. The pervasive myth that the root of the nausea component is a fluctuation of blood between the gut and the extremities is debunked by medical literature that details the human nervous system’s response to pain. The extreme discomfort that is characteristic of the screaming barfies stimulates the nervous system and activates the emetic (vomiting) center, in the area postrema of the brain, a structure in the fourth ventricle whose main function is to detect toxins in the blood and induce an emetic response—that is to say, the barfies.

Prevent the screaming barfies: