Approach Considerations
In considering treatment for motion sickness, the medical provider and the patient must understand that prevention is much more effective than trying to “cure” symptoms once they have started. Both pharmacological and nonpharmacological treatments are more effective if applied before the application of the motion stimuli and should certainly work best if applied before the appearance of significant symptoms.
Multiple pharmacologic treatments exist. [10] As previously stated, they are more effective in preventing motion sickness than treating it and should be taken before motion exposure. In choosing a pharmacological therapy, the patient's age, comorbidities, and current medications should be considered, as well as the length of voyage in which the patient may be susceptible to motion sickness. The 2 classes most commonly used are anticholinergic agents (scopolamine) and antihistamines (dimenhydrinate [Dramamine]). They are discussed in detail, by class, under Medication.
Non-pharmacological prevention
Although pharmacological treatments for motion sickness are generally very effective, non-pharmacological treatments for prevention should be tried as well. Recognizing situations and motions that are likely to produce motion sickness is the most important factor to allow for prevention of symptoms. Minimizing the amount of conflicting vestibular, visual, and proprioceptive sensory information is the goal of the most of the non-pharmacologic treatments.
Avoiding uncomfortable motion stimuli completely by not traveling is rarely practical, but selecting vehicles that produce a minimal amount of motion can help. Large ships on calm seas, comfortable cars (riding in the front seats), and smoothly accelerating trains produce fewer symptoms than small boats in rough weather, buses on mountain roads, and rocking trains.
Habituation
Patients who slowly acclimatize to the motion stimuli generally have less severe symptoms. For example, if preparing for a sea voyage, patients should visit the vessel at dock as early as possible, and spend as much time inside a calm harbor before experiencing the open ocean.
Positioning on the vehicle
Selecting the most stable portion of the vessel is helpful. Patients should attempt to locate themselves near the centerline of the vessel and nearest to the ground or waterline. Conversely, locations below deck and high in the vessel often produce the most uncomfortable motion. Supporting the head to minimize additional head motion and to reduce neck strain helps reduce both vestibular and proprioceptive stimuli.
After all attempts to decrease the amount of motion have been made, adjustments to the characteristics of the motion can be tried. Facing forward or in-line with the direction of the largest motion can reduce the amount of off-axis motion, which can reduce symptoms. Reclining the head back 30º or more can alleviate symptoms by isolating the motion to a single axis within the semicircular canal.
Attempting to reduce conflicting visual stimuli can best be accomplished by attempting to maintain a steady visual horizon with an expansive of a view as possible. Looking down at the floor or water may seem comfortable, but watching the horizon or looking up is more likely to minimize symptoms. Patients should avoid closed spaces without an accurate horizon. Window seats and open-air locations are preferable. If possible, looking forward toward the source of the motion in order to be able anticipate the movements is optimal.
Body position is also very important. In addition to minimizing head motion and neck twisting relative to the patient’s body, patients should face forward in the location of the vehicle with minimal motion. Safely standing with flexed knees and actively anticipating the motion can be effective.
Finally, lying completely prone (with closed eyes) often reduces symptoms to a manageable level presumably by aligning full-body symmetrical proprioceptive input.
Activity on the vehicle
Patients should be instructed to avoid close work, reading, or watching a video screen. Sunglasses can reduce visual input and may be beneficial. If other preventive strategies fail to improve symptoms, closing one’s eyes can reduce symptoms.
Piloting the vessel is another method to synchronize the visual, vestibular, and proprioceptive stimuli. Steering forces the patient to watch the visual horizon, stabilize their head, and receive proprioceptive input from the wheel through their arms. A psychological benefit is likely from taking control of their situation.
Non-pharmacological treatments
Discussing the symptoms of motion sickness often precipitates the condition and frequently increases the symptom severity in persons with mild symptoms. Patients should attempt to reduce as many other noxious stimuli as possible. Avoid any noxious stimuli such as odors, particularly the smell of emesis or hydrocarbons. Avoiding alcohol and other nausea producing substances is essential. The cessation of nicotine ingestion can reduce symptoms. Caffeine may increase some patients’ nausea. Controlled breathing has been shown to suppress symptoms in mild cases. [11]
Patients should avoid becoming dehydrated, getting too cold, too warm, or any other sources of discomfort.
A small study has suggested visually induced motion sickness may be allieviated with pleasant odors. [12]
The importance of psychological and emotional factors on the experience of motion sickness cannot be overlooked. Patients who have anxiety about other portions of their travel experience are much more likely to report the sensations of motion sickness as extremely unpleasant while those individuals who frequently overcome unpleasant noxious stimuli often report motion sickness as a minor inconvenience. [13]
Tips for helping minimize motion are as follows:
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Pick a stable vehicle.
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Occupy the location at the center or the front of vehicle.
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Choose a location near the midline of the vehicle.
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Choose a location at the ground floor or waterline.
Tips for reducing vestibular symptoms are as follows:
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Reduce off-axis motion.
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Support the head.
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Recline head back 30º.
Visual tips for minimizing motion sickness are as follows:
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Try to see a wide horizon.
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Look toward motion.
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Do not do any close work or read.
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Wear sunglasses.
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Close your eyes.
Proprioceptive tips for minimizing motion sickness are as follows:
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Connect with steering device.
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Support head
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Avoid neck torsion
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Stand
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Recline as much as possible
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Lay prone
Other advice for reducing motion sickness is as follows:
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Slowly increase motion stress.
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If possible, pilot the vehicle.
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Avoid other noxious stimuli.
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Avoid noxious odors.
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Avoid alcohol.
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Avoid dehydration.
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Stay comfortably warm and dry.
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Eat soft, bland, light meals.
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Avoid discussing motion sickness.
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Treat gastritis.
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Control negative emotions.
Alternative medicine treatments
Acupuncture and acupressure have been reported to reduce both motion sickness and nausea for many years. Many commercial products purport to treat motion sickness by applying stimulation (eg, needles, pressure, electrical current, magnetic fields, capsicum plaster) to the P6 pressure point on the wrist. None of these devices have been shown to be effective compared to placebos in good quality trials. [14, 15, 16]
Although a large systematic review and metaanalysis has not shown P6 stimulation to be effective for preventing postoperative nausea, some papers have shown them to be effective in in reducing the symptoms of motion sickness in a few small studies. [17, 18, 19]
Other treatment modalities
An entire host of technologies have attempted to prevent motion sickness in laboratory and real-world conditions. These devices typically attempt to synchronize visual and vestibular by altering the visual input. None have been shown to be effective in real-world conditions.
Consultations
Consultations are rarely necessary. Nearly all motion sickness can be prevented or treated with standard behavioral and pharmacological interventions. If standard treatments are unsuccessful and the condition is impacting important aspects of the patient’s quality of life, the case can be discussed with an expert in the field. Typically, flight surgeons who specialize in aeromedical conditions, as well as otolaryngology, neurology, or neuro-otology physicians, have experience with these cases and may accept referrals.
Diet
Reports exist that a bland diet that is high in carbohydrates and low in fats may reduce symptoms. Spicy foods, acidic foods, and other foods that produce gastritis or gastroesophageal reflux are more likely to be associated with stomach awareness, nausea, and vomiting. Patients with a history of gastritis should take measures to treat this before they start vomiting.
Sailors experienced with motion sickness frequently choose to eat sweet, non-spicy, “slippery” foods, which are less uncomfortable for them to vomit after the initiation of seasickness.
Although ginger has been reported as a treatment for motion sickness for many years, few trials show its effectiveness. [20, 21, 22] The literature on ginger for other forms of nausea is larger, but an analysis of these studies don’t not convincingly show any improvement compared to placebo. [23] The history behind ginger as a treatment is long, and some individuals may be helped if they believe in the treatment. [24]
Follow-Up
Further Inpatient Care
No inpatient care is needed.
Further Outpatient Care
Education about prevention and treatment of motion sickness and outpatient prescriptions for pharmacological treatments are frequently the only required outpatient care.
Transfer
Patients with motion sickness very rarely require medical transport primarily. However, patients being transported for other medical reasons frequently develop motion sickness and are often appropriate candidates for preventative pharmacological treatment.
Deterrence/Prevention
See section on non-pharmacological treatments.
Complications
Dehydration, anxiety, and depression are the most common complications of motion sickness.
Prognosis
Symptoms resolve in nearly all patients within 72 hours after the cessation of the motion stimuli.
Patient Education
Patient education is the probably the most important aspect of patient care. Avoidance, motion acclimation, and minimization of motion stimuli are key strategies for avoiding motion sickness. Educating patients to attempt to synchronize vestibular, visual, and proprioceptive stimuli. Informing patient about the importance of personal awareness of the more subtle neurological, psychological, and gastrointestinal symptoms that often precede the nausea and vomiting. Assuring that patients understand that pharmacological treatment works best if started before the onset of symptoms cannot be emphasized enough. Finally, it is important to assure patient that, although severe motion sickness may make patients wish they would die, it is extremely unlikely to kill them.
Special concerns
Self-treatment and prevention of motion sickness is frequently required in situations in which the medical provider is likely to be treating other patients for motion sickness. [25, 26] Prevention and pretreating oneself in the appropriate manner should be carried out before attempting to initiate medical care on others who may be suffering from motion sickness.
