Motion sickness is a common condition that occurs when there is a disconnect between the motion that your inner ear senses and the motion that your eyes see. This can lead to symptoms such as nausea, dizziness, and vomiting.
If you are prone to motion sickness, there are several strategies you can try to help alleviate your symptoms. One common method is to focus on a fixed point in the distance, such as the horizon, to help reorient your senses. You can also try sitting in the front seat of a car or over the wing of an airplane to minimize movement.
Another option is to take over-the-counter medications such as Dramamine or Bonine, which can help reduce symptoms of motion sickness. Ginger supplements or ginger chews are also a natural remedy that some people find effective.
It’s important to stay hydrated and avoid heavy or greasy foods if you are prone to motion sickness. Taking slow, deep breaths and avoiding reading or looking at screens can also help.
If you continue to experience severe motion sickness despite trying these methods, it’s best to consult with a healthcare professional for further guidance and treatment options.
Professional Advice for Motion Sickness
Healthcare providers can offer additional advice on preventing and managing motion sickness. Some tips they may suggest include:
- Using acupressure bands or wristbands designed to alleviate symptoms.
- Prescribing stronger anti-nausea medications for severe cases.
- Suggesting cognitive behavioral therapy techniques to help manage anxiety related to motion sickness.
- Recommendation for vestibular rehabilitation therapy to improve balance and reduce symptoms.
- Referring to a specialist for further evaluation and treatment if motion sickness significantly impacts daily life.
It’s essential to consult with a healthcare professional for personalized advice and treatment options tailored to individual needs.
Historical Perspectives
Ancient physician Hippocrates once noted, “Sailing on the sea disorders the body,” recognizing symptoms of motion sickness over two millennia ago. Today, motion sickness can arise from various environments and activities, affecting individuals with functioning balance systems.
Common Symptoms of Motion Sickness
Common symptoms include nausea, vomiting, drowsiness, warmth sensations, dizziness, pallor, and sweating. Symptoms typically develop gradually and can vary in intensity.
Additional Symptoms of Motion Sickness
Potential Symptoms of Motion Sickness
- Loss of appetite
- Feelings of apathy
- Blurry vision or eye strain
- Excessive sweating
- Challenges with concentration
- Generalized discomfort
- Headaches
- Hyperventilation
- Nausea
- Increased sensitivity to odors
- Excessive salivation
- Vertigo
- Vomiting
Understanding the Science of Motion Sickness
The sensory conflict theory explains motion sickness as a discrepancy between input from the vestibular, visual, and kinesthetic systems and the brain’s internal model. Countermeasures are designed to minimize these conflicts and update the brain’s internal model to adapt to new sensory patterns.
Conclusion
| Preventive Action | Feedback | Potential Constraints |
|---|---|---|
| Adaptation through habituation (desensitization) | Highly efficient; habituation acquired over time more effective than existing anti-motion sickness medications and without side effects | Gradual process, specific to certain stimuli, may require occasional re-exposure |
| Acquiring visual horizon guidance | Offers safety measures across various forms of transport | May not be viable under certain circumstances |
|---|
| Reclining on back | Could help minimize the motion of the head | May not be suitable for various activities |
|---|
Key Points on Motion Sickness
In addition to habituation, there are other measures that can help alleviate motion sickness to some extent.
Individual susceptibility and risk factors
Children under the age of 2 are typically not affected by motion sickness. The susceptibility to motion sickness is highest between the ages of 7 and 12, decreasing with age. Women may have a higher susceptibility compared to men. Factors such as hormones and genetics are also influential in determining susceptibility levels.
Other risk factors for motion sickness include lack of exposure to motion, such as traveling by car or boat infrequently. Certain medications, such as those that affect the inner ear, can also increase the likelihood of experiencing motion sickness. Additionally, individuals who have a history of migraines or have a pre-existing vestibular disorder may be more susceptible to motion sickness.
Behavioral and other nonpharmacologic countermeasures
Being aware of and avoiding triggers are crucial in the prevention of motion sickness. Behavioral interventions are vital in managing symptoms. Factors like lack of sleep, alcohol consumption, and smoking can exacerbate symptoms. Distractions, controlled breathing techniques, and natural remedies may provide some relief.
Pharmacologic countermeasures
Medication can be an effective solution when habituation is not feasible. It is recommended to take medication before the onset of symptoms. Different medications have varying degrees of effectiveness and may come with side effects. Refer to Table 7.6.2 for a list of common medications and dosing recommendations for adults.
Table 7.6.2: Characteristics of common anti-motion-sickness drugs in adults
| Medication | Brand Name Example | Administration Route | Recommended Dosage for Adults | Onset of Action (hours) | Duration of Effect (hours) | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Scopolamine NonUS | Kwells | Administration Method: Oral | Dosage: 0.3–0.6 mg | Frequency: 1/2–1 times a day | Duration: 4 days | ||||||
| Name: Scopolamine |
| Administration: Intramuscular |
| Dosage: 0.1–0.2 mg |
| Frequency: Once every 4 hours |
| Total: 4 doses per day |
| Scopolamine | Transderm Scop | Transdermal patch | 1 milligram | Every 6 to 8 hours | Lasts up to 72 hours |
| Promethazine | Suppository | 25 mg | 1 | 15 |
| Name | Brand | Administration | Dosage | Frequency | Hours |
| Dimenhydrinate OTC | Dramamine (original) | Oral | 50–100 mg | 2 times a day | Every 8 hours |
| Antiemetic drug: | Brand name: | Route of administration: | Dosage: | Number of tablets: | Total amount: |
| Cyclizine | Marezine | Oral | 50 mg | 2 | 6 |
| Drug Name: | Cyclizine |
| Type: | Injection |
| Dosage: | 50 mg |
| Number of doses: | 1/4 |
| Frequency: | 6 times a day |
| Meclizine | Antivert | Oral | 25–50 mg | 2 times a day | Every 8 hours |
| Common OTC Meclizine Brands | Brands: Bonine, Dramamine (less drowsy) |
| Form | Chewable tablets |
| Dosage | 25–50 mg |
| Numer of Tablets | 2 |
| Duration of Effect | 8–24 hours |
| Drug Name: Buclizine |
| Route of Administration: Oral |
| Dosage: 50 mg |
| Number of Tablets: 1 |
| Total Tablets: 6 |
| Brand Name: | Stugeron |
| Generic Name: | Cinnarizine NonUS |
| Administration: | Oral |
| Dosage: | 15–30 mg |
| Number of Tablets: | 4 |
| Total Tablets: | 8 |
Important Information
Definitions: NonUS – unavailable in the U.S.; H – hours.
There are various trade names for the same medication, some of which may differ between countries: dimenhydrinate (Gravol, Driminate, Dramamine original); meclizine (Bonamine, Bonine, Antivert, Postafen, Sea Legs, Dramamine Less Drowsy); cyclizine (Marezine, Cyclivert); buclizine is sometimes mistakenly called Buclizine (Antivert).
Certain medications may be available over the counter in one country but require a prescription in another.
Data adapted from Benson, A. J. (2002). Medical aspects of harsh environments, motion sickness (pp. 1048–1083). Office of The Surgeon General Department of the Army, United States of America.
In addition to behavioral methods and anti-motion-sickness drugs, there are other strategies that can help children cope with motion sickness. For example, encouraging them to look at a fixed point in the distance, taking breaks during long trips, and providing distractions like music or games can all help alleviate symptoms.
It is important to note that every child is different, so what works for one may not work for another. Parents should pay attention to their child’s specific triggers and reactions to motion sickness in order to find the most effective solution.
Furthermore, it is crucial for parents to pack essentials like plastic bags, wipes, and extra clothes in case of vomiting. Being prepared can help minimize stress and discomfort for both the child and the rest of the family while traveling.
Overall, with patience and careful planning, parents can help their children manage motion sickness and enjoy their travel experiences to the fullest.
Mal de debarquement
Mal de debarquement (French for “sickness of disembarkation”) is the lingering feeling of imbalance or rocking after being exposed to passive motion, notably after sea voyages. It is normal to experience a brief sensation of this kind, occasionally without nausea, which usually resolves within hours. Transient imbalance may affect elderly individuals upon disembarking from cruises. In rare cases, there is a condition known as mal de debarquementt syndrome where symptoms last for weeks or more. In such instances, consulting a specialist in vestibular disorders is advisable.
Medical management of motion sickness
Healthcare providers treating patients with acute motion sickness symptoms should rule out other potential causes, such as peripheral and central vestibular disease. Individuals with a history of migraines, which can trigger or worsen motion sickness, may benefit from migraine treatments either preventatively or after symptoms begin.
Reassurance and keeping the patient lying down are supportive measures. In case of vomiting, ensuring adequate fluid and electrolyte intake is essential. In severe motion sickness cases, alternative routes of administering anti-motion-sickness drugs may be necessary due to impaired oral absorption caused by gastric stasis, even without vomiting. Intramuscular injection may be considered in severe cases (Table 7.6.2). Transdermal and suppository routes are less effective due to slower absorption rates. Behavioral strategies may also offer relief (Table 7.6.1).
Motion sickness is a natural reaction to unfamiliar stimuli. Although it is most common in children under 12, infants rarely experience it. As the condition stems from central and vestibular factors, centrally acting medications may be helpful. There is no evidence supporting the use of drugs in children under two years old. Effective medications for older children may include hyoscine and antihistamines, which can have anticholinergic side effects. Ginger and acupuncture bands could be options, although their efficacy has only been proven in adults.
Introduction
Motion sickness is prevalent, with around 30% of the population experiencing symptoms during travel, and 5% having severe symptoms. Specific statistics for children are not available. Children under two years old are typically resistant to motion sickness due to their position and lack of spatial cues. The peak susceptibility is around 10–12 years of age. Motion sickness in children commonly occurs during car, train, and air travel, as well as on amusement rides and virtual reality experiences.
Simple preventive measures can reduce the likelihood of motion sickness (refer to the box). If these methods fail, pharmacological treatments may be considered for children over two years old.
Rationale for pharmacological management
Symptoms such as paleness and cold sweat, usually followed by stomach discomfort, nausea, and vomiting, result from conflicting signals from the vestibular, visual, and proprioception systems. Young children may experience dizziness and clumsiness. Prolonged motion sickness can lead to drowsiness, apathy, and a sense of impending danger. Anticipatory nausea before travel may involve cortical centers.
The first mention of a motion sickness remedy dates back to the 1860s in the Lancet, recommending belladonna tincture.
Promethazine was approved in the 1950s, and it was in the 1970s that cholinergic stimulation was identified as the basis of motion sickness. Antihistamines and anticholinergics are commonly used, targeting various areas in the body.
Ginger supplements have also been found to be effective in reducing symptoms of motion sickness. Studies have shown that ginger can help alleviate nausea and vomiting associated with motion sickness.
Treatment options (see ref. 2)
When dealing with motion sickness-prone children, consider the following:
- Motion sickness can delay drug absorption due to gastric stasis, making prevention more effective than treatment.
- There is a lack of controlled trials on anti-motion sickness medications in young children, so treatment is based on pharmacological principles and adult data.
- While most anti-motion sickness meds induce drowsiness, they should not be used to sedate children during air travel, as excessive sedation combined with reduced oxygen levels can be hazardous.
- All anti-motion sickness medications also act as effective antiemetics.
Box Simple ways to prevent travel sickness 2,4
- Redirect the child’s attention elsewhere, like looking outside the vehicle or at the horizon when possible.
- Avoid encouraging reading or gaming during travel.
- Minimize head movements with pillows or headrests.
- Situate the child near the front of the vehicle while driving, preferably in the middle rather than the rear seats.
- Opt for a seat over the airplane wing for smoother travel.
- Have the child recline as far back as feasible.
- Offer a light snack before travel, avoiding heavy meals.
- Ensure good ventilation, either through an open window or air conditioning, and prevent overheating.
- Stay calm, as anxiety about experiencing motion sickness can raise the chances of an episode.
Efficacy and safety
Hyoscine hydrobromide (scopolamine)
A review of 14 controlled trials on hyoscine found it more effective than a placebo but not superior to antihistamines. The studies mainly involved adult males. Hyoscine is less sedating than antihistamines but has more anticholinergic effects.
Antihistamines
Antihistamines (H1 receptor antagonists) should not be given to children under two years old for motion sickness, or with caution in older children due to potential adverse effects. Fatalities have occurred in young children due to over-the-counter antihistamines. Dosing for motion sickness in children is inferred from adult studies, and sedating antihistamines are now prescription-only in Australia and New Zealand for children under two.
Promethazine theoclate, promethazine hydrochloride, and dimenhydrinate are approved in Australia for motion sickness prevention, to be taken at least 30 minutes before travel. Diphenhydramine is not approved for this use in Australia. Non-sedating antihistamines like loratadine and cetirizine are ineffective against motion sickness.
Complementary alternatives
Acupuncture wristbands at the P6 Neiguan point have shown relief for nausea in adults but not definitively for motion sickness. Placebo treatments have been beneficial in up to 45% of cases. Ginger has antiemetic properties but limited evidence in children for motion sickness treatment. Prism glasses have reduced vomiting in children with motion sickness.
International treatments
Hyoscine patches for motion sickness are available for children over 10 years old in other countries. Cinnarizine and flunarizine have been effective in preventing car sickness in children.
Conclusion
Various remedies are marketed for motion sickness in children, but few have been thoroughly studied for them. Recent changes in antihistamine availability for young children highlight the necessity of continual medication assessment.
Self-test questions
True or False:
1. Children should not be sedated with antihistamines when traveling by plane.
2. Motion sickness medication should be taken at least 30 minutes before starting a journey.