History

Exposure to real or perceived motion stimuli is required for the syndrome to be categorized as motion sickness. Motion stimuli may be categorized as a vertical linear acceleration (heave), horizontal translational motion in the lateral direction (sway), the fore-and-aft movement (surge), and/or an angular roll. The maximum symptoms frequently appear with motions with a frequency of 0.2 Hz (one cycle every 5 seconds). Long period motions like those experienced on a tilting train or large ship can be barely perceptible but still cause the syndrome. Virtual motions such as in a large video screen, microfiche reader, or other visual motions can precipitate motion sickness.^[7]

Nausea is the hallmark symptom, although it is frequently preceded by several more subtle symptoms. These preceding symptoms are commonly described as generalized feeling of unwellness (malaise), drowsiness, fatigue, and irritability. They can be quite subtle and easily mistaken for emotional responses to the situation. An early sensation of “stomach awareness,” described as a fullness and discomfort in the epigastrium, is frequently the first reported symptom.

Nausea and vomiting in motion sickness and can be quite severe. A nonvertiginous dizziness sometimes associated and exaggerated sense of motion and difficulty ambulating.

Sopite syndrome, which is a constellation of symptoms that involves apathy, depression, disinclination for work, and decreased participation in group activities, can occur.^[8]These and other neurophysiologic symptoms such as maliase, lethargy and agitation can persist for some time after the motion stimuli has ended.

The sensation of movement frequently persists after the cessation of motion. This syndrome, called mal de debarque, is considered worrisome if it lasts for longer than 3 days.^[9]

Patients who have previously experience motion sickness are much more likely to experience it again. Along with pregnant women, patients with previous vestibular syndromes or illness, a propensity toward nausea, and patients with a migraine headache history have increased rates of motion sickness.

Physical Examination

Besides vomiting, there are few detectable physical signs of motion sickness. Yawning and belching can be observed before conscious symptoms develop. Peri-oral and facial pallor can give patients a green appearance and can occur along with increased salivation, diaphoresis, and flushing. Increased postural sway, changes in electrogastrography, and decreases in skin resistance have all been correlated with the sensations of motion sickness.

Causes

See Pathophysiology.

Differential Diagnoses

Murdin L, Golding J, Bronstein A. Managing motion sickness. BMJ. 2011. 343:d7430. [QxMD MEDLINE Link].
Shupak A, Gordon CR. Motion sickness: advances in pathogenesis, prediction, prevention, and treatment. Aviat Space Environ Med. 2006 Dec. 77(12):1213-23. [QxMD MEDLINE Link].
Golding JF. Motion sickness susceptibility. Auton Neurosci. 2006 Oct 30. 129(1-2):67-76. [QxMD MEDLINE Link].
Nachum Z, Shupak A, Gordon CR. Transdermal scopolamine for prevention of motion sickness : clinical pharmacokinetics and therapeutic applications. Clin Pharmacokinet. 2006. 45(6):543-66. [QxMD MEDLINE Link].
Dobie TG, May JG. Cognitive-behavioral management of motion sickness. Aviat Space Environ Med. 1994 Oct. 65(10 Pt 2):C1-2. [QxMD MEDLINE Link].
Lawther A, Griffin MJ. A survey of the occurrence of motion sickness amongst passengers at sea. Aviat Space Environ Med. 1988 May. 59(5):399-406. [QxMD MEDLINE Link].
Haward BM, Lewis CH, Griffin MJ. Motions and crew responses on an offshore oil production and storage vessel. Appl Ergon. 2009 Sep. 40(5):904-14. [QxMD MEDLINE Link].
Chan G, Moochhala SM, Zhao B, Wl Y, Wong J. A comparison of motion sickness prevalence between seafarers and non-seafarers onboard naval platforms. Int Marit Health. 2006. 57(1-4):56-65. [QxMD MEDLINE Link].
Klosterhalfen S, Kellermann S, Pan F, Stockhorst U, Hall G, Enck P. Effects of ethnicity and gender on motion sickness susceptibility. Aviat Space Environ Med. 2005 Nov. 76(11):1051-7. [QxMD MEDLINE Link].
Brainard A, Gresham C. Prevention and treatment of motion sickness. Am Fam Physician. 2014 Jul 1. 90 (1):41-6. [QxMD MEDLINE Link].
Holtmann S, Clarke AH, Scherer H, Höhn M. The anti-motion sickness mechanism of ginger. A comparative study with placebo and dimenhydrinate. Acta Otolaryngol. 1989 Sep-Oct. 108(3-4):168-74. [QxMD MEDLINE Link].
Keshavarz B, Stelzmann D, Paillard A, Hecht H. Visually induced motion sickness can be alleviated by pleasant odors. Exp Brain Res. 2015 May. 233 (5):1353-64. [QxMD MEDLINE Link].
Grontved A, Brask T, Kambskard J, Hentzer E. Ginger root against seasickness. A controlled trial on the open sea. Acta Otolaryngol. 1988 Jan-Feb. 105(1-2):45-9. [QxMD MEDLINE Link].
Stewart JJ, Wood MJ, Wood CD, Mims ME. Effects of ginger on motion sickness susceptibility and gastric function. Pharmacology. 1991. 42(2):111-20. [QxMD MEDLINE Link].
White B. Ginger: an overview. Am Fam Physician. 2007 Jun 1. 75(11):1689-91. [QxMD MEDLINE Link].
Ozgoli G, Goli M, Simbar M. Effects of ginger capsules on pregnancy, nausea, and vomiting. J Altern Complement Med. 2009 Mar. 15(3):243-6. [QxMD MEDLINE Link].
Yen Pik Sang FD, Golding JF, Gresty MA. Suppression of sickness by controlled breathing during mildly nauseogenic motion. Aviat Space Environ Med. 2003 Sep. 74(9):998-1002. [QxMD MEDLINE Link].
Dobie TG, May JG. Cognitive-behavioral management of motion sickness. Aviat Space Environ Med. 1994 Oct. 65(10 Pt 2):C1-2. [QxMD MEDLINE Link].
Miller KE, Muth ER. Efficacy of acupressure and acustimulation bands for the prevention of motion sickness. Aviat Space Environ Med. 2004 Mar. 75(3):227-34. [QxMD MEDLINE Link].
Stern RM, Hu S, LeBlanc R, Koch KL. Chinese hyper-susceptibility to vection-induced motion sickness. Aviat Space Environ Med. 1993 Sep. 64(9 Pt 1):827-30. [QxMD MEDLINE Link].
Dobie T, McBride D, Dobie T Jr, May J. The effects of age and sex on susceptibility to motion sickness. Aviat Space Environ Med. 2001 Jan. 72(1):13-20. [QxMD MEDLINE Link].
Golding JF, Gresty MA. Motion sickness. Curr Opin Neurol. 2005 Feb. 18(1):29-34. [QxMD MEDLINE Link].
Lawson BD, Mead AM. The sopite syndrome revisited: drowsiness and mood changes during real or apparent motion. Acta Astronaut. 1998 Aug-Sep. 43(3-6):181-92. [QxMD MEDLINE Link].
Cha YH. Mal de debarquement. Semin Neurol. 2009 Nov. 29(5):520-7. [QxMD MEDLINE Link].
Wood CD, Manno JE, Wood MJ, Manno BR, Mims ME. Comparison of efficacy of ginger with various antimotion sickness drugs. Clin Res Pr Drug Regul Aff. 1988. 6(2):129-36. [QxMD MEDLINE Link].
Estrada A, LeDuc PA, Curry IP, Phelps SE, Fuller DR. Airsickness prevention in helicopter passengers. Aviat Space Environ Med. 2007 Apr. 78(4):408-13. [QxMD MEDLINE Link].
Spinks A, Wasiak J. Scopolamine (hyoscine) for preventing and treating motion sickness. Cochrane Database Syst Rev. 2011. (6):CD002851. [QxMD MEDLINE Link].
Nachum Z, Shupak A, Gordon CR. Transdermal scopolamine for prevention of motion sickness : clinical pharmacokinetics and therapeutic applications. Clin Pharmacokinet. 2006. 45(6):543-66. [QxMD MEDLINE Link].
Nachum Z, Shahal B, Shupak A, Spitzer O, Gonen A, Beiran I. Scopolamine bioavailability in combined oral and transdermal delivery. J Pharmacol Exp Ther. 2001 Jan. 296(1):121-3. [QxMD MEDLINE Link].
Simmons RG, Phillips JB, Lojewski RA, Wang Z, Boyd JL, Putcha L. The efficacy of low-dose intranasal scopolamine for motion sickness. Aviat Space Environ Med. 2010 Apr. 81(4):405-12. [QxMD MEDLINE Link].
Doweck I, Gordon CR, Spitzer O, Melamed Y, Shupak A. Effect of cinnarizine in the prevention of seasickness. Aviat Space Environ Med. 1994 Jul. 65(7):606-9. [QxMD MEDLINE Link].
Gordon CR, Gonen A, Nachum Z, Doweck I, Spitzer O, Shupak A. The effects of dimenhydrinate, cinnarizine and transdermal scopolamine on performance. J Psychopharmacol. 2001 Sep. 15(3):167-72. [QxMD MEDLINE Link].
Buckey JC Jr, Alvarenga DL, MacKenzie TA. Chlorpheniramine and ephedrine in combination for motion sickness. J Vestib Res. 2007. 17(5-6):301-11. [QxMD MEDLINE Link].
Cox DJ, Singh H, Cox DM. Effectiveness of acupressure and acustimulation in minimizing driving simulation adaptation syndrome. Mil Med. 2011 Dec. 176(12):1440-3. [QxMD MEDLINE Link].
Wood CD, Manno JE, Wood MJ, Manno BR, Mims ME. Comparison of efficacy of ginger with various antimotion sickness drugs. Clin Res Pr Drug Regul Aff. 1988. 6(2):129-36. [QxMD MEDLINE Link].
Lee A, Fan LT. Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting. Cochrane Database Syst Rev. 2009. (2):CD003281. [QxMD MEDLINE Link].
Hu S, Stritzel R, Chandler A, Stern RM. P6 acupressure reduces symptoms of vection-induced motion sickness. Aviat Space Environ Med. 1995 Jul. 66(7):631-4. [QxMD MEDLINE Link].
Bertolucci LE, DiDario B. Efficacy of a portable acustimulation device in controlling seasickness. Aviat Space Environ Med. 1995 Dec. 66(12):1155-8. [QxMD MEDLINE Link].
Gil A, Nachum Z, Tal D, Shupak A. A comparison of cinnarizine and transdermal scopolamine for the prevention of seasickness in naval crew: a double-blind, randomized, crossover study. Clin Neuropharmacol. 2012 Jan. 35(1):37-9. [QxMD MEDLINE Link].
Bar R, Gil A, Tal D. Safety of double-dose transdermal scopolamine. Pharmacotherapy. 2009 Sep. 29(9):1082-8. [QxMD MEDLINE Link].
Hershkovitz D, Asna N, Shupak A, Kaminski G, Bar R, Tal D. Ondansetron for the prevention of seasickness in susceptible sailors: an evaluation at sea. Aviat Space Environ Med. 2009 Jul. 80(7):643-6. [QxMD MEDLINE Link].
McClure JA, Lycett P, Baskerville JC. Diazepam as an anti-motion sickness drug. J Otolaryngol. 1982 Aug. 11(4):253-9. [QxMD MEDLINE Link].
Muth ER, Elkins AN. High dose ondansetron for reducing motion sickness in highly susceptible subjects. Aviat Space Environ Med. 2007 Jul. 78(7):686-92. [QxMD MEDLINE Link].
Weichenthal L, Soliz T. The incidence and treatment of prehospital motion sickness. Prehosp Emerg Care. 2003 Oct-Dec. 7(4):474-6. [QxMD MEDLINE Link].
Wright MS, Bose CL, Stiles AD. The incidence and effects of motion sickness among medical attendants during transport. J Emerg Med. 1995 Jan-Feb. 13(1):15-20. [QxMD MEDLINE Link].
Golding JF, Gresty MA. Pathophysiology and treatment of motion sickness. Curr Opin Neurol. 2015 Feb. 28 (1):83-8. [QxMD MEDLINE Link].

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Author

Andrew Brainard, MD, MPH Consultant Emergency Medical Physician, Director of Emergency Medical Education, Middlemore Hospital, New Zealand

Andrew Brainard, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Wilderness Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Chip Gresham, MD, FACEM † Emergency Medicine Physician, Medical Toxicologist, and Intensive Care Consultant, Department of Emergency Medicine, Clinical Director of Medication Safety, Middlemore Hospital; Consultant Toxicologist, National Poisons Centre; Director, Auckland Regional Toxicology Service; Senior Lecturer, Auckland University Medical School, New Zealand

Chip Gresham, MD, FACEM is a member of the following medical societies: American College of Emergency Physicians, American College of Medical Toxicology, Australasian College for Emergency Medicine, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Selim R Benbadis, MD Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida Morsani College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, American Medical Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Bioserenity, Ceribell, Eisai, Jazz, LivaNova, Neurelis, Neuropace, SK life science, Sunovion, Takeda, UCB<br/>Serve(d) as a speaker or a member of a speakers bureau for: Aquestive, Bioserenity, Eisai, Jazz, LivaNova, Neurelis, SK life science, Stratus, Sunovion, UCB<br/>Received research grant from: Cerevel Therapeutics, Ovid Therapeutics, Neuropace, Greenwich Jazz, SK Life Science, Xenon Pharmaceuticals, UCB, Marinus, Neuroelectrics Corporation, Longboard, Janssen, Equilibre Biopharmaceuticals.

Sections Motion Sickness
Overview
- Background
- Pathophysiology
- Prevalence
- Mortality/Morbidity
- Race
- Sex
- Age
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Presentation
DDx
Workup
Treatment
Medication
Questions & Answers
References

Motion Sickness Clinical Presentation

History

Physical Examination

Causes

References

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