Motion sickness

Signs and Symptoms

The most common signs and symptoms of motion sickness include:

• Nausea and vomiting
• Pale skin
• Cold sweats
• Dizziness
• Headache
• Increased salivation
• Fatigue

Causes

Motion sickness happens when the body, the inner ear, and the eyes send conflicting signals to the brain. This most often happens when you are in a car, boat, or airplane, but it may also happen on flight simulators or amusement park rides. From inside a ship's cabin, your inner ear may sense rolling motions that your eyes cannot see. On the other hand, your eyes may see movement on a "virtual reality" ride that your body does not feel. Even viewing a 3D movie may cause symptoms of motion sickness.

Once a person gets used to the movement and the motion stops, symptoms may come back (although usually only briefly). Sometimes just thinking about movement can cause fear and symptoms of motion sickness. For example, a person who had motion sickness before might get nauseous on an airplane before take-off.

Risk Factors

The following are the most common risk factors for motion sickness:

• Riding in a car, boat, airplane, or other moving vehicle.
• Age. Between 2 and 12.
• Gender. Women have a higher risk than men.
• Sleep deprivation.
• Alcohol or drug use.
• History of migraine, anxiety, frequent vomiting or nausea.
• Cigarette smoke or odors, such as those from diesel, gasoline, exhaust, or from certain foods.
• Poor ventilation in the vehicle.
• Sitting in the back seat or where you cannot see out the window.
• Pregnancy.

Diagnosis

Your doctor will ask about your symptoms and find out what usually causes the problem. Your doctor does not usually need laboratory tests to make a diagnosis.

Preventive Care

There are several ways you can try to prevent car motion sickness:

• Sit in the front seat in a car.
• Keep your eyes on the horizon.
• DO NOT read.
• Rest your head against the seat back, to keep it still.
• Turn the air vents toward your face.
• DO NOT smoke.

If you have motion sickness on a plane, try these tips:

• Avoid big, greasy meals and alcohol the night before air travel.
• Eat light meals or snacks that are low in calories in the 24 hours before air travel.
• Sit toward the front of the aircraft or in a seat over the wing.
• Turn the air vent flow toward your face.

If you have motion sickness on a boat, try these tips:

• Ask for a cabin on the upper deck or towards the front of the ship.
• When on deck, keep your eyes fixed on the horizon or land.

Treatment

You can use medication to control your symptoms. If you travel often, you may want to learn to control, and prevent symptoms. Mind-body practices, such as cognitive-behavioral therapy and biofeedback, may help. Other alternatives include:

• Changes to your diet
• Physical exercise
• Acupuncture

Medications

Medications for motion sickness may cause drowsiness. Pilots, ship crew members, or anyone operating heavy equipment or driving a car should not take them. These medications may help:

• Scopolamine (Transderm Scop). Most commonly prescribed medication for motion sickness. You have to take it before symptoms start. It comes in patch form to put behind your ear 6 to 8 hours before travel. If the patch is left in place, effects last up to 3 days. Side effects may include dry mouth, drowsiness, blurred vision, and disorientation.
• Promethazine (Phenergan). Administered 2 hours before travel. The effects last 6 to 12 hours. Side effects include drowsiness and dry mouth.
• Cyclizine (Marezine). Works best when taken at least 30 minutes before travel. It is not recommended for children younger than 6, and side effects are similar to scopolamine.
• Dimenhydrinate (Dramamine). Take every 4 to 8 hours. Side effects are similar to scopolamine.
• Meclizine (Bonine). Works best when taken 1 hour before travel. Side effects include drowsiness and dry mouth.

Nutrition and Dietary Supplements

A comprehensive treatment plan to treat motion sickness may include a range of complementary and alternative therapies. Ask your team of health care providers about the best ways to incorporate these therapies into your overall treatment plan. Always tell your provider about the herbs and supplements you are using or considering using.

Following these nutritional tips may help reduce symptoms:

• Avoid spicy, greasy, or fatty meals.
• DO NOT overeat before traveling.
• Drink plenty of water.
• Dry crackers and carbonated sodas (such as ginger ale) help some people avoid nausea.
• People who tend to have motion sickness may want to eat small, frequent meals.

Herbs

Supplements and herbs are marketed in the United States without requirements for safety or effectiveness. There are no credible studies showing that herbs used for motion sickness treatment are safe or work.

The following herbs are sometimes used for nausea and may provide some relief for motion sickness:

• Ginger (Zingiber officinale). Ginger is a traditional remedy for nausea and vomiting, and some studies show it may help with motion sickness. Other studies have found it does not work, however. Ginger may increase the risk of bleeding, especially if you also take blood-thinners such warfarin (Coumadin), clopidogrel (Plavix), or aspirin. If you have a heart condition, talk to your doctor before taking ginger.
• Peppermint (Mentha piperita). Peppermint may help with nausea symptoms in motion sickness. Peppermint can interact with some medications. Ask your doctor before taking it.
• Black horehound (Ballotta nigra). Although black horehound is sometimes used by people who experience motion sickness, no scientific studies have been done to see if it is safe or if it works. Black horehound can interact with Parkinson medications, and may be harmful to some people with Parkinson or Schizophrenia.

Acupuncture

Some studies suggest that acupressure may help reduce symptoms of motion sickness in the same way as acupuncture. An acupressure practitioner works with the same points used in acupuncture, but uses finger pressure rather than needles. Acupressure bands are available commercially to help prevent motion sickness. Studies suggest these bands may help delay the onset of symptoms.

Traditionally, the acupuncture point known as Pericardium 6 is said to help relieve nausea. It is on the inside of the wrist, about the length of 2 fingernails up the arm from the center of the wrist crease.

Homeopathy

No scientific studies validated the use of homeopathy for treatment of motion sickness. The following homeopathic remedies are sometimes used for nausea:

• Borax
• Cocculus
• Nux vomica
• Petroleum
• Sepia
• Tabacum

Mind-Body Medicine

Biofeedback Training and Relaxation

Biofeedback training may help you relax. You may also learn to control your body responses to decrease nausea and vomiting. Combining biofeedback with gradual muscle relaxation may control nausea in a more effective way.

Cognitive Behavioral Therapy

Cognitive behavioral therapy may be helpful in reducing the anxiety that some people with motion sickness experience.

Breathing Techniques

Rapid and shallow breathing often makes symptoms of motion sickness worse. Slow paced diaphragmatic breathing techniques have been explored. While it makes sense that slow, deeper breathing would help lower anxiety, more studies are needed to see whether breathing techniques really help reduce other symptoms.

Other Considerations

Prognosis and Complications

Although motion sickness usually goes away after the motion stops and causes no lasting harm, it can be devastating for people whose jobs involve constant movement, such as:

• Flight attendants
• Pilots
• Astronauts
• Ship crew members

People who do not travel often may get used to movement during a trip lasting several days. Even those who travel often may find that symptoms get better as they are more often exposed to motion. However, people who get anxious before a journey often have worsened symptoms of motion sickness. They may need help such as biofeedback and relaxation training.

Supporting Research

Brainard A, Gresham C. Prevention and treatment of motion sickness. Am Fam Physician. 2014;90(1):41-46. PMID: 25077501 www.ncbi.nlm.nih.gov/pubmed/25077501.

Chumpitazi BP, Kearns GL, Shulman RJ. Review article: the physiological effects and safety of peppermint oil and its efficacy in irritable bowel syndrome and other functional disorders. Aliment Pharmacol Ther. 2018;47(6):738-752. PMID: 29372567 www.ncbi.nlm.nih.gov/pubmed/29372567.

Cox DJ, Singh H, Cox DM. Effectiveness of acupressure and acustimulation in minimizing driving simulation adaptation syndrome. Mil Med. 2011;176(12):1440-1443. PMID: 22338362 www.ncbi.nlm.nih.gov/pubmed/22338362.

Crane BT, Eggers SDZ, Zee DS. Central vestibular disorders. In: Flint PW, Haughey BH, Lund V, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 6th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 166.

Ferri FF. Motion sickness. In: Ferri FF, ed. Ferri's Clinical Advisor 2019. Philadelphia, PA: Elsevier; 2019:909.e4-909.e4.

Golding JF. Motion sickness. Handb Clin Neurol. 2016;137:371-390. PMID: 27638085 www.ncbi.nlm.nih.gov/pubmed/27638085.

Hass DJ. Complementary and alternative medicine. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 131.

Koretz RL, Rotblatt M. Complementary and alternative medicine in gastroenterology: the good, the bad, and the ugly. Clin Gastroenterol Hepatol. 2004;2(11):957-967. PMID: 15551247 www.ncbi.nlm.nih.gov/pubmed/15551247.

Michelfelder AJ. Acupuncture for nausea and vomiting. In: Rakel D, ed. Integrative Medicine. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 111.

Murray MT. Mentha piperita (peppermint). In: Pizzorno JE, Murray MT, eds. Textbook of Natural Medicine. 4th ed. St Louis, MO: Elsevier Churchill Livingstone; 2013:chap 105.

Murray MT. Zingiber officinale (ginger). In: Pizzorno JE, Murray MT, eds. Textbook of Natural Medicine. 4th ed. St Louis, MO: Elsevier Churchill Livingstone; 2013:chap 140.

Palatty PL, Haniadka R, Valder B, Arora R, Baliga MS. Ginger in the prevention of nausea and vomiting: a review. Crit Rev Food Sci Nutr. 2013;53(7):659-669. PMID: 23638927 www.ncbi.nlm.nih.gov/pubmed/23638927.

Streitberger K, Ezzo J, Schneider A. Acupuncture for nausea and vomiting: an update of clinical and experimental studies. Auton Neurosci. 2006;129(1-2):107-117. PMID:16950659 www.ncbi.nlm.nih.gov/pubmed/16950659.

Stromberg SE, Russell ME, Carlson CR. Diaphragmatic breathing and its effectiveness for the management of motion sickness. Aerosp Med Hum Perform. 2015;86(5):452-457. PMID: 25945662 www.ncbi.nlm.nih.gov/pubmed/25945662.