Introduction:

Motion sickness is a normal response to real, perceived, or even anticipated movement. People tend to get motion sickness on a moving boat, train, airplane, car, or amusement park rides. Although this condition is fairly common and often only a minor nuisance, it may be incapacitating for people who travel frequently -- although the more you travel, the more you get used to the motion.

Signs and Symptoms:

The most common signs and symptoms of motion sickness include:

• Nausea
• Paleness of the skin
• Cold sweats
• Vomiting
• Dizziness
• Headache
• Increased salivation
• Fatigue

Causes:

Motion sickness occurs when the body, the inner ear, and the eyes send conflicting signals to the brain. This most often happens when a person is in a moving vehicle such as a car, boat, or airplane, but it may also happen on flight simulators or amusement park rides. From inside a ship's cabin, the inner ear may sense rolling motions that the eyes cannot see, and, conversely, the eyes may see movement on a "virtual reality" simulation ride that the body does not feel. Interestingly, once a person gets used to the movement and the motion stops, symptoms may return (although usually only briefly). Sometimes just anticipating movement can cause anxiety and symptoms of motion sickness. For example, a person who had previously had motion sickness might become 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 space shuttle
• Young age -- children ages 2 - 12 are most likely to get motion sickness.
• Susceptibility to nausea or vomiting
• Heightened level of fear or anxiety
• Poor ventilation in the vehicle
• Sitting in the back seat or where you cannot see out the window

Diagnosis:

Most people who have had motion sickness in the past ask their health care provider how to prevent it next time. Your doctor will ask about your symptoms and find out what usually causes the problem (such as riding in a boat, flying in a plane, or driving in car). Laboratory tests are generally not necessary to establish a diagnosis of motion sickness.

Preventive Care:

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

• Sit in the front seat in a car.
• Keep your eyes on the horizon. Don't read.
• Rest your head against the seat back, to keep it still.
• Turn the air vents toward your face.
• Don't 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.
• Avoid salty foods and dairy products before air travel.
• Sit toward the front of the aircraft or in a seat by the wing.
• Turn the air vent flow toward your face.

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

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

Treatment:

You can use medication to control your symptoms, but people who travel often will want to learn to control -- and eventually prevent -- these symptoms. Mind-body practices, such as cognitive-behavioral therapy and biofeedback, may help. Other alternatives to medication include homeopathy, acupuncture, dietary supplements, dietary changes, and physical exercise.

Medications

Medications for motion sickness may cause drowsiness and impair judgment. Pilots, ship crew members, or anyone operating heavy equipment or driving a car should not take them. The following medications may be helpful to people who experience motion sickness motion sickness occasionally:

• Scopolamine (Transderm Scop) -- most commonly prescribed medication for motion sickness. It must be taken before symptoms start. It is available as a patch form that is placed behind the ear 6 - 8 hours before travel. The effects last up to 3 days. Side effects may include dry mouth, drowsiness, blurred vision, and disorientation.
• Promethazine (Phenergan) -- take 2 hours before travel. The effects last 6 - 8 hours. Side effects may include drowsiness and dry mouth.
• Cyclizine (Marezine) -- most effective 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 - 8 hours. Side effects are similar to scopolamine.
• Meclizine (Bonine) -- most effective when taken 1 hour before travel. It is not recommended for children under 12, and side effects may include drowsiness and dry mouth.

Nutrition and Dietary Supplements

People who are prone to motion sickness may want to eat small, frequent meals. 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 health care provider about the herbs and supplements you are using or considering using.

Following these nutritional tips may help reduce symptoms and improve overall health:

• Avoid spicy, greasy, or fatty meals.
• Don't overeat.
• Drink plenty of water.
• Dry crackers and carbonated drink (such as ginger ale) help some people avoid nausea.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

• Ginger (Zingiber officinale) standardized extract, 250 mg three times daily as needed, for symptoms of nausea. Ginger is a traditional remedy for nausea, and some studies show it may help with motion sickness -- although others find it has no benefit.
• Peppermint (Mentha piperita) standardized extract, 1 enteric coated tablet two to three times daily as needed. You may also make a tea of the leaf.
• Black horehound (Ballotta nigra), 1 - 2 ml as a tincture or 1 -2 tsp. of leaves steeped as a tea, taken three times per day. This is a traditional remedy for motion sickness, but no scientific studies have been done to test the benefits.

Acupuncture

Some studies suggest that acupressure may help reduce symptoms of motion sickness in the same way as acupuncture, although the evidence is not clear. An acupressure practitioner works with the same points used in acupuncture, but stimulates these healing sites with finger pressure, rather than inserting fine needles.

The acupuncture point known as Pericardium 6, traditionally has been said to help relieve nausea. It is located on the inside of the wrist, about the length of 2 fingernails up the arm from the center of the wrist crease. Many travel stores sell wrist bands with built in buttons designed to apply acupressure to this point.

Homeopathy

Few studies have examined the effectiveness of specific homeopathic remedies. A professional homeopath, however, may recommend one or more of the following treatments for motion sickness based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person’s constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

• Borax -- for nausea caused by downward motions, such as landing in an airplane
• Cocculus -- the primary treatment for motion sickness, particularly if nausea and vertigo or other type of dizziness are present
• Nux vomica -- for motion sickness accompanied by headache, nausea, and ringing in the ears
• Petroleum -- for dizziness and nausea that occur when riding in a car or boat
• Sepia -- for motion sickness brought on by reading while in a moving vehicle
• Tabacum -- for motion sickness with severe nausea and vomiting

There are "combination" remedies that include these remedies together. Although a classically trained homeopath may frown upon such combinations, some find them easier and effective for home use.

Mind-Body Medicine

Biofeedback Training and Relaxation

In a study of 55 pilots who had to stop flying due to motion sickness, 76% of them successfully overcame their motion sickness and were able to return to work after participating in a biofeedback training and relaxation program. The pilots were exposed to a situation causing motion sickness (sitting in a tilting, rotating chair) while biofeedback instruments recorded skin temperature and changes in muscle tension. While in the chair, the pilots used relaxation techniques, such as deep muscle relaxation and mental imagery. Over time, the pilots became used to the rotating chair and no longer felt sick as they learned to relax.

Cognitive Behavioral Therapy

The goal of cognitive behavioral therapy is to lessen the anxiety that some people have just thinking about movement or motion sickness. In a study of 50 pilots who occasionally had motion sickness, 86% of them overcame their symptoms after cognitive behavioral therapy. During this therapy, people are exposed to a situation that causes motion sickness (such as a tilting, rotating chair) in a slow fashion until they experience some symptoms of motion sickness, but not until the symptoms become overwhelming. As they tolerate the movement more, they build confidence, reducing their anxiety.

Breathing Techniques

In a study of 46 people with motion sickness, those who took slow, deep breaths had a significant reduction in symptoms of motion sickness compared to those who breathed normally or counted their breaths. Involuntary rapid and shallow breathing often exacerbates symptoms of motion sickness. While it makes sense that slow, deliberate breathing would help reduce anxiety associated with motion sickness, more studies are needed to determine whether breathing techniques really help in reducing 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 a flight attendant, pilot, astronaut, or ship crew member.

People who don't travel often may get used to movement during a trip lasting several days. Even those who travel often may find that symptoms improve as they are frequently exposed to motion. However, people who become anxious before a journey often have worsened symptoms of motion sickness. They may need more formal interventions, such as biofeedback and relaxation training.