Prevention and Treatment of Motion Sickness



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Am Fam Physician. 2014 Jul 1;90(1):41-46.

This clinical content conforms to AAFP criteria for continuing medical education (CME). See CME Quiz Questions.

  Patient information: See related handout on motion sickness, written by the authors of this article.

Motion sickness is a common syndrome that occurs upon exposure to certain types of motion. It is thought to be caused by conflict between the vestibular, visual, and other proprioceptive systems. Although nausea is the hallmark symptom, it is often preceded by stomach awareness, malaise, drowsiness, and irritability. Early self-diagnosis should be emphasized, and patients should be counseled about behavioral and pharmacologic strategies to prevent motion sickness before traveling. Patients should learn to identify situations that will lead to motion sickness and minimize the amount of unpleasant motion they are exposed to by avoiding difficult conditions while traveling or by positioning themselves in the most stable part of the vehicle. Slow, intermittent exposure to the motion can reduce symptoms. Other behavioral strategies include watching the true visual horizon, steering the vehicle, tilting their head into turns, or lying down with their eyes closed. Patients should also attempt to reduce other sources of physical, mental, and emotional discomfort. Scopolamine is a first-line medication for prevention of motion sickness and should be administered transdermally several hours before the anticipated motion exposure. First-generation antihistamines, although sedating, are also effective. Nonsedating antihistamines, ondansetron, and ginger root are not effective in the prevention and treatment of motion sickness.

Motion sickness is a syndrome that occurs when a patient is exposed to certain types of motion and usually resolves soon after its cessation. It is a common response to motion stimuli during travel. Although nausea is a hallmark symptom, the syndrome includes symptoms ranging from vague malaise to completely incapacitating illness. These symptoms, which can affect the patient's recreation, employment, and personal safety, can occur within minutes of experiencing motion and can last for several hours after its cessation.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendation Evidence rating References

To prevent and reduce symptoms of motion sickness, passengers should look forward at a fixed point on the horizon and avoid close visual tasks.

C

25

To prevent and reduce symptoms of motion sickness in vehicles, passengers should actively steer, tilt their head into turns, recline, stabilize their head and body, or rest with their eyes closed.

C

68

Scopolamine should be a first-line medication for preventing motion sickness in persons who wish to maintain wakefulness during travel.

A

1, 2, 14, 15, 20, 21, 24

First-generation antihistamines are effective for preventing motion sickness, but often have sedative and other side effects.

B

1, 2, 16, 17, 1921, 26


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

View Table

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendation Evidence rating References

To prevent and reduce symptoms of motion sickness, passengers should look forward at a fixed point on the horizon and avoid close visual tasks.

C

25

To prevent and reduce symptoms of motion sickness in vehicles, passengers should actively steer, tilt their head into turns, recline, stabilize their head and body, or rest with their eyes closed.

C

68

Scopolamine should be a first-line medication for preventing motion sickness in persons who wish to maintain wakefulness during travel.

A

1, 2, 14, 15, 20, 21, 24

First-generation antihistamines are effective for preventing motion sickness, but often have sedative and other side effects.

B

1, 2, 16, 17, 1921, 26


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

Nearly all persons will have symptoms in response to severe motion stimuli, and a history of motion sickness best predicts future symptoms.1 Females, children two to 15 years of age, and persons with conditions associated with nausea (e.g., early pregnancy, migraines, vestibular syndromes) report increased susceptibility.

Etiology

The pathogenesis of motion sickness is not clearly understood, but it is thought to be related to conflict between the vestibular, visual, and other proprioceptive systems.2 Rotary, vertical, and low-frequency motions produce more symptoms than linear, horizontal, and

The Authors

ANDREW BRAINARD, MD, MPH, FACEM, FACEP, is an emergency medicine physician at Middlemore Hospital, Auckland, New Zealand. He is co-director of emergency medical education for Middlemore Emergency Department and a senior lecturer at the University of Auckland School of Medicine.

CHIP GRESHAM, MD, FACEM, FAAEM, is an emergency medicine physician and medical toxicologist at Middlemore Hospital. He is the clinical director of medication safety at Middlemore Hospital, and a senior lecturer at the University of Auckland School of Medicine.

Author disclosure: No relevant financial affiliations.

Address correspondence to Andrew Brainard, MD, MPH, Middlemore Hospital, 100 Hospital Rd., Papatoetoe, Auckland, New Zealand, 2025 (e-mail: abrainard01@gmail.com). Reprints are not available from the authors.

REFERENCES

1. Golding JF. Motion sickness susceptibility. Auton Neurosci. 2006;129(1–2):67–76.

2. Shupak A, Gordon CR. Motion sickness: advances in pathogenesis, prediction, prevention, and treatment. Aviat Space Environ Med. 2006;77(12):1213–1223.

3. Turner M, Griffin MJ. Motion sickness in public road transport: the relative importance of motion, vision and individual differences. Br J Psychol. 1999;90(pt 4):519–530.

4. Griffin MJ, Newman MM. Visual field effects on motion sickness in cars. Aviat Space Environ Med. 2004;75(9):739–748.

5. Bos JE, MacKinnon SN, Patterson A. Motion sickness symptoms in a ship motion simulator: effects of inside, outside, and no view. Aviat Space Environ Med. 2005;76(12):1111–1118.

6. Wada T, Konno H, Fujisawa S, Doi S. Can passengers' active head tilt decrease the severity of carsickness? Effect of head tilt on severity of motion sickness in a lateral acceleration environment. Hum Factors. 2012;54(2):226–234.

7. Rolnick A, Lubow RE. Why is the driver rarely motion sick? The role of controllability in motion sickness. Ergonomics. 1991;34(7):867–879.

8. Gahlinger PM. Cabin location and the likelihood of motion sickness in cruise ship passengers. J Travel Med. 2000;7(3):120–124.

9. Dobie TG, May JG. The effectiveness of a motion sickness counselling programme. Br J Clin Psychol. 1995;34(pt 2):301–311.

10. Yen Pik Sang FD, Billar JP, Golding JF, Gresty MA. Behavioral methods of alleviating motion sickness: effectiveness of controlled breathing and a music audiotape. J Travel Med. 2003;10(2):108–111.

11. Horing B, Weimer K, Schrade D, et al. Reduction of motion sickness with an enhanced placebo instruction: an experimental study with healthy participants. Psychosom Med. 2013;75(5):497–504.

12. Eden D, Zuk Y. Seasickness as a self-fulfilling prophecy: raising self-efficacy to boost performance at sea. J Appl Psychol. 1995;80(5):628–635.

13. Denise P, Vouriot A, Normand H, Golding JF, Gresty MA. Effect of temporal relationship between respiration and body motion on motion sickness. Auton Neurosci. 2009;151(2):142–146.

14. Spinks A, Wasiak J. Scopolamine (hyoscine) for preventing and treating motion sickness. Cochrane Database Syst Rev. 2011;(6):CD002851.

15. 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;35(1):37–39.

16. Estrada A, LeDuc PA, Curry IP, Phelps SE, Fuller DR. Airsickness prevention in helicopter passengers. Aviat Space Environ Med. 2007;78(4):408–413.

17. Brand JJ, Colquhoun WP, Gould AH, Perry WL. (—)-Hyoscine and cyclizine as motion sickness remedies. Br J Pharmacol Chemother. 1967;30(3):463–469.

18. Weinstein SE, Stern RM. Comparison of marezine and dramamine in preventing symptoms of motion sickness. Aviat Space Environ Med. 1997;68(10):890–894.

19. Paul MA, MacLellan M, Gray G. Motion-sickness medications for aircrew: impact on psychomotor performance. Aviat Space Environ Med. 2005;76(6):560–565.

20. Sherman CR. Motion sickness: review of causes and preventive strategies. J Travel Med. 2002;9(5):251–256.

21. Zajonc TP, Roland PS. Vertigo and motion sickness. Part II: pharmacologic treatment. Ear Nose Throat J. 2006;85(1):25–35.

22. Gordon CR, Shupak A. Prevention and treatment of motion sickness in children. CNS Drugs. 1999;12(5):369–381.

23. McDonald K, Trick L, Boyle J. Sedation and antihistamines: an update. Review of inter-drug differences using proportional impairment ratios. Hum Psychopharmacol. 2008;23(7):555–570.

24. Nachum Z, Shupak A, Gordon CR. Transdermal scopolamine for prevention of motion sickness: clinical pharmacokinetics and therapeutic applications. Clin Pharmacokinet. 2006;45(6):543–566.

25. Bar R, Gil A, Tal D. Safety of double-dose transdermal scopolamine. Pharmacotherapy. 2009;29(9):1082–1088.

26. Cheung BS, Heskin R, Hofer KD. Failure of cetirizine and fexofenadine to prevent motion sickness. Ann Pharmacother. 2003;37(2):173–177.

27. McClure JA, Lycett P, Baskerville JC. Diazepam as an anti-motion sickness drug. J Otolaryngol. 1982;11(4):253–259.

28. Furman JM, Marcus DA, Balaban CD. Rizatriptan reduces vestibular-induced motion sickness in migraineurs. J Headache Pain. 2011;12(1):81–88.

29. Muth ER, Elkins AN. High dose ondansetron for reducing motion sickness in highly susceptible subjects. Aviat Space Environ Med. 2007;78(7):686–692.

30. 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;80(7):643–646.

31. Grøntved A, Brask T, Kambskard J, Hentzer E. Ginger root against seasickness. A controlled trial on the open sea. Acta Otolaryngol. 1988;105(1–2):45–49.

32. Alkaissi A, Ledin T, Odkvist LM, Kalman S. P6 acupressure increases tolerance to nauseogenic motion stimulation in women at high risk for PONV. Can J Anaesth. 2005;52(7):703–709.



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