Motion Sickness - home health advice

Overview
Definition

Motion sickness is discomfort that occurs during travel in a moving vehicle such as a car, boat, or airplane. It represents a normal response to sensory conflict and changes in motion patterns.
Etiology

Motion sickness occurs when vestibular system input conflicts with visual cues, e.g., when the body senses rolling motions which are not visually apparent from inside a ship's cabin, or conversely during a "virtual reality" simulation when the eyes perceive movement that is not experienced by the body. Asymmetry can occur between right and left otolith mass.
Risk Factors

* Exposure to motion stimuli
* Youth and/or inexperience with the form of motion
* Predisposition to nausea or vomiting
* Fear or anxiety
* Exposure to unpleasant odors
* Poor ventilation
* Zero gravity
* Asian descent
* Female gender

Signs and Symptoms

* Dizziness
* Pallor
* Cold sweating
* Hypersalivation
* Nausea
* Vomiting
* Fatigue
* Headache
* Malaise

Differential Diagnosis

* Migraine
* Vestibular disease
* Metabolic disorders
* Vertigo
* Viral illness

Diagnosis

Patient rarely arrives at a physician's office actually suffering from motion sickness; more often a health care provider will be asked for advice and preventives after an episode or in anticipation of future travel.
Physical Examination

Patient may appear pale and/or weak, complain of nausea, and possibly have an elevated heart rate.
Laboratory Tests

Laboratory tests are not necessary to establish a diagnosis of motion sickness. However, in clinical studies, elevated salivary cortisol is sometimes used as an index.
Other Diagnostic Procedures

Question patient about the precipitating event and course and duration of symptoms to establish a diagnosis of motion sickness.
Treatment Options
Treatment Strategy

Motion sickness is not in itself dangerous, but may become dangerous if it occurs during the operation of machinery or during driving. Removing or minimizing exposure to the stimuli will help to alleviate the symptoms. Avoid fixation on moving objects.
Drug Therapies

For the short term, suggest OTC antihistamines:

* Cyclizene (Marezine): 50 mg 30 to 60 minutes before travel and every four to six hours as necessary. For children ages 6 to 11, 25 mg every six to eight hours. Not recommended for children younger than 6.
* Dimenhydrinate (Dramamine): 50 to 100 mg every four to six hours. For children ages 6 to 11, 25 to 50 mg every six to eight hours. For children ages 2 to 5, 12.5 to 25 mg every six to eight hours.
* Meclizine (Bonine, Antivert, Dramamine II): 25 to 50 mg once daily. Not recommended for patients younger than 12.

Antihistamines are effective for both prevention and treatment. These products are contraindicated in patients with breathing problems, glaucoma, or an enlarged prostate causing difficulties in urination. Antihistamines often cause drowsiness and should not be used while driving. The drowsiness effect is most pronounced with dimenhydrinate.

For the longer term, scopolamine patch placed behind the ear six to eight hours before travel will last up to three days. Side effects may include dry mouth, drowsiness, blurred vision, and disorientation. Scopolamine is not effective if administered after the onset of symptoms and may interact with alcohol, antihistamines, and antidepressants.

Phenytoin, amphetamine, and other norepinephrine-releasing agents (e.g., 25 mg promethazine in combination with 25 mg ephedrine one hour before travel) can be effective if not contraindicated.
Complementary and Alternative Therapies

Digestive herbs and/or homeopathic remedies may be helpful in preventing and relieving motion sickness. As with most therapies, alternative therapies for motion sickness are best used before the onset of symptoms.
Nutrition

Avoid alcohol and caffeine. If there is concurrent respiratory involvement, eliminate pro-inflammatory and mucus promoting foods such as dairy products, fruit, and sugar. Ginger root (Zingiber officinale) sliced and chewed may prevent the onset of motion sickness. Encapsulated ginger, crystallized ginger, or ginger snaps may also be effective. Ginger may be as effective as Dramamine if taken one hour before needed. Sips of lemon water may help relieve nausea from motion sickness.
Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, it is important to ascertain a diagnosis before pursuing treatment. Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups/day. Tinctures may be used singly or in combination as noted.

Ginger root in a tea (frequent small sips) or tincture (30 drops in ? cup of water as needed). May add peppermint (Mentha piperita) and/or chamomile (Matricaria recutita) if there is vomiting.

Black horehound (Ballota nigra) may help relieve nausea secondary to inner ear problems. May be used as tea (1 cup tid) or tincture (30 drops tid).
Homeopathy

An experienced homeopath should assess individual constitutional types and severity of disease to select the correct remedy and potency. For acute prescribing use 3 to 5 pellets of a 12X to 30C remedy every one to four hours until acute symptoms resolve.

* Cocculus for motion sickness and vertigo from watching moving objects.
* Petroleum for motion sickness with cold sensation in the abdomen.
* Tabacum for unrelenting nausea with cold sweat.

Acupuncture

P6 acupressure may reduce symptoms of sea sickness. Use "Sea Bands" as commercially available, as these may be very effective.
Massage

Massage or other relaxation techniques may help control motion sickness.
Patient Monitoring

Patients should be instructed to report any unusual side effects resulting from medication for motion sickness.
Other Considerations
Prevention

Patients should avoid reading while in a moving vehicle, preferably keeping their eyes on the scene outside. Driving or piloting the vehicle provides protection from motion sickness, since it necessarily involves constant observation of the outside environment. For children, an elevated car seat allowing a view out the window is helpful. Patients should get as much fresh air as possible, avoid twisting the neck, and avoid eating or drinking heavily before travel. If possible, select a seat or cabin where the vehicle's motion is least perceptible, such as near the waterline of a boat or in the center of a plane. Diaphragmatic breathing may help prevent motion sickness.
Complications/Sequelae

Motion sickness has no long-term complications.
Prognosis

The symptoms generally disappear quickly after travel is concluded. Patients often acclimate during a trip of several days or after repeated exposures to the same type of experience.
Pregnancy

Ginger should be used with caution in the first trimester of pregnancy.
References

Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, Mass: Integrative Medicine Communications; 1998:429.

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

Gresty MA, Grunwald EA. Medical perspective of motion sickness. In: Proceedings of the International Workshop on Motion Sickness: Medical and Human Factors; May 1997; Marbella, Spain.

Helling K, Hausmann S, Flottmann T, Scherer H. Individual differences in susceptibility to motion sickness [in German]. HNO. 1997;45:210-215.

Hoffman D. The New Holistic Herbal. New York, NY: Barnes & Noble Books; 1995:181.

Hu S, Stritzel R, Chandler A, Stern RM. P6 acupressure reduces symptoms of vection-induced motion sickness. Aviat Space Environ Med. 1995;66:631-634.

Jozsvai EE, Pigeau RA. The effect of autogenic training and biofeedback on motion sickness tolerance. Aviat Space Environ Med. 1996;67:963-968.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany, Calif: Hahnemann Clinic Publishing; 1993:133, 288, 379.

Pray WS. Motion sickness: a sensory conflict. U.S. Pharmacist. March 1998.

Ramsey A. Virtual reality induced symptoms and effects: a psychophysiological prespective. In: Proceedings of the International Workshop on Motion Sickness: Medical and Human Factors; May 1997; Marbella, Spain.

Stern RM, Hu S, Uijtdehaage SH, Muth ER, Xu LH, Koch KL. Asian hypersusceptibility to motion sickness. Hum Hered. 1996;46:7-14.