MOTION SICKNESS

Definition [1]

Motion sickness is the uncomfortable dizziness, nausea, and vomiting that people experience when their sense of balance and equilibrium is disturbed by constant motion. Riding in a car, aboard a ship or boat, or riding on a swing all cause stimulation of the vestibular system and visual stimulation that often leads to discomfort. While motion sickness can be bothersome, it is not a serious illness, and can be prevented.

Description [2]

Motion sickness is a common problem, with nearly 80% of the general population suffering from it at one time in their lives.

When looking at why motion sickness occurs, it is helpful to understand the role of the sensory organs. The sensory organs control a body’s sense of balance by telling the brain what direction the body is pointing, the direction it is moving, and if it is standing still or turning. These messages are relayed by the inner ears (or labyrinth); the eyes; the skin pressure receptors, such as in those in the feet; the muscle and joint sensory receptors, which track what body parts are moving; and the central nervous system (the brain and spinal cord), which is responsible for processing all incoming sensory information.

Motion sickness and its symptoms surface when conflicting messages are sent to the central nervous system. An example of this is reading a book in the back seat of a moving car. The inner ears and skin receptors sense the motion, but the eyes register only the stationary pages of the book. This conflicting information may cause the usual motion sickness symptoms of dizziness, nausea and vomiting.

Causes and symptoms [3]

While all five of the body’s sensory organs contribute to motion sickness, excess stimulation to the vestibular system within the inner ear (the body’s “balance center”) has been shown to be one of the primary reasons for this condition. Balance problems, or vertigo, are caused by a conflict between what is seen and how the inner ear perceives it, leading to confusion in the brain. This confusion may result in higher heart rates, rapid breathing, nausea and sweating, along with dizziness and vomiting.

Pure optokinetic motion sickness is caused solely by visual stimuli, or what is seen. The optokinetic system is the reflex that allow the eyes to move when an object moves. Many people suffer when what they view is rotating or swaying, even if they are standing still.

Additional factors that may contribute to the occurrence of motion sickness include:

  • Poor ventilation.
  • Anxiety or fear. Both have been found to lower a person’s threshold for experiencing motion sickness symptoms.
  • It is recommended that a heavy meal of spicy and greasy foods be avoided before and during a trip.
  • A drink is often thought to help calm the nerves, but in this case it could upset the stomach further. A hangover for the next morning’s trip may also lead to motion sickness.
  • Genetic factors. Research suggests that some people inherit a predisposition to motion sickness. This predisposition is more marked in some ethnic groups than in others; one study published in 2002 found that persons of Chinese or Japanese ancestry are significantly more vulnerable to motion sickness than persons of British ancestry.
  • Pregnancy. Susceptibility in women to vomiting during pregnancy appears to be related to motion sickness, although the precise connections are not well understood as of 2004.

Often viewed as a minor annoyance, some travelers are temporarily immobilized by motion sickness, and a few continue to feel its effects for hours and even days after a trip (the “mal d’embarquement” syndrome).

Diagnosis

Most cases of motion sickness are mild and self-treatable disorders. If symptoms such as dizziness become chronic, a doctor may be able to help alleviate the discomfort by looking further into a patient’s general health. Questions regarding medications, head injuries, recent infections, and other questions about the ear and neurological system will be asked. An examination of the ears, nose, and throat, as well as tests of nerve and balance function, may also be completed.

Severe cases of motion sickness symptoms, and those that become progressively worse, may require additional, specific tests. Diagnosis in these situations deserves the attention and care of a doctor with specialized skills in diseases of the ear, nose, throat, equilibrium, and neurological system.

Treatment

There are a variety of medications to help ease the symptoms of motion sickness, and most of these are available without a prescription. Known as over-the-counter (OTC) medications, it is recommended that these be taken 30-60 minutes before traveling to prevent motion sickness symptoms, as well as during an extended trip.

Drugs

The following OTC drugs consist of ingredients that have been considered safe and effective for the treatment of motion sickness:

  • Marezine (and others). Includes the active ingredient cyclizine and is not for use in children under age 6.
  • Benadryl (and others). Includes the active ingredient diphenhydramine and is not for use in children under age 6.
  • Dramamine (and others). Includes the active ingredient dimenhydrinate and is not for use in children under age 2.
  • Bonine (and others). Includes the active ingredient meclizine and is not for use in children under age 12.

Each of the active ingredients listed above are antihistamines whose main side effect is drowsiness. Caution should be used when driving a vehicle or operating machinery, and alcohol should be avoided when taking any drug for motion sickness. Large doses of OTC drugs for motion sickness may also cause dry mouth and occasional blurred vision.

The side effects of cinnarizine and the other antihistamine antiemetics indicate that they should not be used by members of flight crews responsible for the control of aircraft or for other tasks that require sustained attention and alertness.

People with emphysema, chronic bronchitis, glaucoma, or difficulty urinating due to an enlarged prostate is recommended do not use OTC drugs for motion sickness unless directed by their doctor.

Alternative treatment

Alternative treatments for motion sickness have become widely accepted as a standard means of care. Ginger (Zingiber officinale) [4] [5] in its various forms is often used to calm the stomach, and it is now known that the oils it contains (gingerols and shogaols) appear to relax the intestinal tract in addition to mildly depressing the central nervous system. Some of the most effective forms of ginger include the powdered, encapsulated form; ginger tea prepared from sliced ginger root; or candied pieces. All forms of ginger should be taken on an empty stomach.

 

Prognosis

While there is no cure for motion sickness, its symptoms can be controlled or even prevented. Most people respond successfully to the variety of treatments, or avoid the unpleasant symptoms through prevention methods.

Prevention

Because motion sickness is easier to prevent than treat once it has begun, the best treatment is prevention. The following steps may help deter the unpleasant symptoms of motion sickness before they occur:

  • Avoid reading while traveling, and do not sit in a backward facing seat.
  • Always ride where the eyes may see the same motion that the body and inner ears feel. Safe positions include the front seat of the car while looking at distant scenery; the deck of a ship where the horizon can be seen; and sitting by the window of an airplane. The least motion on an airplane is in a seat over the wings.
  • Maintain a fairly straight-ahead view.
  • Eat a light meal before traveling, or if already nauseated, avoid food altogether.
  • Avoid watching or talking to another traveler who is having motion sickness.
  • Take motion sickness medicine at least 30-60 minutes before travel begins, or as recommended by a physician.
  • Learn to live with the condition. Even those who frequently endure motion sickness can learn to travel by anticipating the conditions of their next trip. Research also suggests that increased exposure to the stimulation that causes motion sickness may help decrease its symptoms on future trips.

Notes:

[1] Motion sickness: more than nausea and vomiting. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4112051/ 
[2] Motion sickness: an overview. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7048153/ 
[3] Motion Sickness: Current Knowledge and Recent Advance. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6492910/
[4] Efficacy of ginger for nausea and vomiting: a systematic review of randomized clinical trials. https://academic.oup.com/bja/article/84/3/367/264600
[5]Three statistical experimental designs for enhancing yield of active compounds from herbal medicines and anti-motion sickness bioactivity https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4522827/

[6] Ginger on Human Health: A Comprehensive Systematic Review of 109 Randomized Controlled Trials. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019938/