Motion Sickness – Causes, Symptoms, Diagnosis, Treatment

Motion sickness is also called “kinetosis” describes as physiologic abnormal responses to your eye, nervous system, brain to travel in sea, car, train, air, plane, and virtual reality immersion disorder. It gave sufficient stimulus, all people with functional vestibular systems and develop motion sickness with a set of symptoms that occur in association with the motion of a person or his or her surroundings area, triggering a stress reaction, autonomic symptoms, intersensory conflict model, incorporating the vestibular, visual, and proprioceptive systems. It basically varies with susceptibility to autonomic nervous symptoms, ranging from fatigue to massive vomiting, cold sweats, pallor, nausea, vomiting are caused by a stress reaction to the motion, induced by passive movement at low frequencies (0.2 to 0.4 Hz) in situations without any visual reference system to the horizontal plane. The onset is often insidious, with drowsiness, yawning, and reduced alertness cold sweating and pallor, salivation, and occasionally headache, to nausea and vomiting with incapacitation that can be severe [.

Types of Motion Sickness

  • Carsickness – Cause a specific form of motion sickness, being carsick is quite common and proved by disorientation thinking, seeing while reading a map, a book, or a small screen during travel. Carsickness results from the sensory conflict arising in the brain from differing sensory inputs into the inner ear. Motion sickness is caused by a conflict between signals arriving in the brain and from the inner ear, which forms the base of the vestibular system, the sensory parts that deal with movement and balance, and which detect motion mechanically.[rx]
  • Airsickness – Airsickness is a kind of rounded motion sickness caused by certain sensations when air travel.[rx] It is a specific form of motion sickness which is considered a normal response in healthy individuals’ ears but it is not normal. An airplane can cause bank and tilt sharply, and unless passengers are sitting by a window, they are likely to see only the stationary interior of the plane due to the small size window and during flights especially at night. Another factor is that while in flight, the see out of windows may be blocked by clouds, cold weather, snow and preventing passengers from seeing the moving ground or passing clouds.
  • Seasickness – Seasickness is a form of terrestrial or top-level motion sickness characterized by a feeling of nausea and, in extreme cases, vertigo, dizziness experienced after spending time on a boat.[rx] It is essentially the same as carsickness, though the motion of a watercraft tends to be more regular. It is typically brought on by the rocking motion of the craft[rx][rx] or movement while the craft is immersed in water.[rx]
  • Centrifuge motion sickness – It is a rotating device such as centrifuges used in astronaut training and amusement park rides such as the rotor, mission, space, and the gravitation that can cause motion sickness in many people. While the interior of the centrifuge does not appear to move, one will experience a real sense of motion. In addition, centrifugal force can cause the vestibular system to give one the sense that the downside is in the direction that is away from the center of the centrifuge rather than the true downward direction.
  • Dizziness due to spinning – When one spins and stops suddenly, fluid in the inner ear continues to rotate causing a sense of continued spinning movement while one’s visual system no longer detects motion.

Causes of Motion Sickness

Your brain creates sensory movement by getting signals from the inner ears, eyes, muscles, and joints, and sensory movement body. When it gets signals from external that do not match, you can get motion sickness more easily. For example, if you are reading on your phone while riding a bus, your eyes are focused on something that is not moving, but your inner ear senses motion.

Motion sickness can be divided into the following categories

  • Motion sickness caused by motion that is felt but not seen, as in terrestrial motion sickness in most cases.
  • Motion sickness caused by motion that is seen but not felt, as in space motion sickness in some cases;
  • The motion sickness caused when both systems of the body detect motion but they do not correspond correctly, as in either terrestrial types or space motion sickness.
  • In these cases, the motion is sensed by only the vestibular system and the motion is felt, but no motion or little motion is detected by the visual system, as fall in motion sickness.
  • Previous family history of motion sickness.
  • Hormonal birth control abnormality.
  • Inner ear disorders especially any disease condition.
  • Menstrual periods.
  • Migraines.
  • Parkinson’s disease.
  • Pregnancy.
  • Eyes see trees passing by in train journey and register movement.
  • Inner ears sense movement disturbance.
  • Muscles and joints sense that your body is sitting still.
  • The brain senses disconnect from these messages.
  • Amusement park riding and virtual reality show experiences.
  • Reading while in motion in some cases.
  • Riding especially in a boat, car, bus, train, or plane.
  • Video games and movies show a long time see.

Symptoms of Motion Sickness

  • Pallor, sweating, hypersalivation, and stomach awareness, throbbing pain
  • Sopite syndrome referring to drowsiness, dizziness, lethargy, and persistent fatigue [rx].
  • Occasionally tiredness can last for hours to days an episode of motion sickness, especially known as sopite syndrome.[rx]
  • Rarely severe symptoms such as the inability to walk, ongoing vomiting, or social isolation may occur.[rx]
  • Nausea
  • Vomiting and retching
  • Sweating
  • Cold sweats
  • Excessive salivation
  • Apathy
  • Hyperventilation or lack of ventilation
  • Increased sensitivity to odors, and abnormal sense
  • Loss of appetite
  • Headache
  • Drowsiness
  • Warm sensation
  • General discomfort

Treatment of Motion Sickness

Behavioral Management

In most cases, behavioral countermeasures against motion sickness are among the most effective in treatments.

Nonpharmacologic treatment

  • Being aware of and avoiding situations that tend to symptoms.
  • Optimizing position to reduce motion or motion perception such as driving a vehicle instead of riding in it, sitting in the front seat of a car or bus is best, sitting over the wing of an aircraft in most cases, holding the head firmly against the back of the seat, and choosing a window-side seat on flights and trains journey.
  • Reducing sensory input lying prone, shutting eyes, sleeping, or looking at the horizon position.
  • Maintaining proper hydration by drinking water, eating small meals frequently, and limiting alcohol consumption and caffeinated beverages, cold drinks.
  • Avoiding smoking even short-term cessation reduces maximum susceptibility to motion sickness.
  • Adding distractions controlling breathing, listening to music, or using aromatherapy scents such as mint or lavender.
  • The flavored lozenges may also be helpful.
  • Proper using acupressure or acupressure or magnets is advocated by some to prevent or treat nausea, although evidence-based scientific data on the efficacy of these treatments for preventing motion sickness are lacking.
  • Gradually exposing oneself to continuous or repeated motion sickness triggers. Most people, in time, notice a reduction in motion sickness symptoms.
  • Relaxation something to focus on, whether it’s taking deep breaths or counting backward from 100. Losing your eyes can help too.
  • Look at a stable object you’re on a boat, look at the horizon. If you’re in a car, look through the windshield.
  • Avoid alcohol.
  • Eat lightly before travel but don’t fast.
  • Breathe fresh air and don’t smoke.
  • Avoid reading.

Short-term maneuvers include

  • Body postural changes reducing head movements, restraining and restricted movement of the head, shoulders, hips, and knees may also help.
  • Sitting in a forward-facing seat, a front seat, or actively steering the vehicle
  • Focusing on a stable horizon position
  • Controlled, mindful breathing systems
  • Avoiding nicotine and smoking(if the patient is a smoker)
  • Listening to pleasant music that heart touching
  • Avoiding travel on turbulent conditions or with poor visibility condition
Non-drug interventions for motion sickness*1
General principle Measure / comment / special feature Reference
Behavioral strategy
Habituating to the motion pattern Habituate through prolonged exposure: E.g.. in many people the symptoms of sea sickness regress markedly after a few days at sea Astronauts habituate to microgravity (– )
Support habituation e.g.. with physiotherapy exercises ►Comment/special feature: – Reactive exercises. willful countermovements of the head (, )
Support habituation exercises with virtual reality (, )
Reducing intersensory conflict Reduce vestibular stimuli ►Comment/special feature:  – Avoid movements outside the axes of motion  – Avoid low-frequency movements, especially vertical ones (e.g.. pitching of a ship): – On a ship: amidships is better than at the bow or stern; focus on the horizon – In a car: face forward and look outward – In an airplane: be seated over the wing – In a bus or train: face the direction of travel, look forward and outward ()
Synchronizing the visual system with the motion Focus on the horizon and on a distant point ►Comment/special feature: – If watching the horizon is not possible, it may help to close eyes and minimize head movements ()
Optokinetic exercises and visual fixation (, )
Use an „artificial“ horizon ►Comment/special feature: – E.g., head-mounted displays or special glasses that provide information about the horizon (,)
Actively synchronizing the body with the motion Perform active synchronizing movements (e.g.. tilt head into turns), walk around actively, take over steering/control. if possible ()
Breathing technique Practice active deep diaphragmatic breathing (, )
Alternative approaches to symptom relief
Using dietary supplements Ginger (, )
Vitamin C ()
Using placebo effect Placebo (, )
Placebo plus positive expectations ()
Using music and pleasant odors Pleasant music ()
Pleasant odors ()
Other approaches
Nerve stimulation Transcutaneous electrical nerve stimulation (TENS) (, )
Magnetic stimulation Transcranial magnetic stimulation or direct current stimulation for „mal de débarquement“ syndrome (, )
Acupressure ►Comment/special feature: – Efficacy not proven for motion sickness. but proven for postoperative vomiting (P6 point stimulation) (, )
Evidence assessment (SORT rating) Evidence assessment according to the SORT rating system (www.aafp.org/afpsort) ►Comment/special feature: – Publications: all clinical studies of the past 10 years on non-drug treatment, search terms „motion sickness,“ „seasickness,“ „simulator sickness,“ „kinetosis“ (PubMed) plus relevant reviews and individual findings

Pharmacologic Therapy

Medications for the treatment of motion sickness are partially effective and may have some unwanted side effects.  They are most effective when used or at the early onset of symptoms. Patients should be encouraged to first try the medications first in a safe before using them during work or travel.

Medications can subdivide into categories anticholinergic, antihistamine, and sympathomimetic.

Anticholinergic

  • Scopolamine – It is the most effective agent presently, acting on nonselective antimuscarinic receptors by inhibiting input to the vestibular nuclei.  It has less sedation than antihistamines and the same group of drugs. The patch should be applied to the mastoid region at least 4 hours before traveling, with effects lasting for 72 hours maximumly.  Common side effects include dry eyes and mouth, photosensitivity, blurred vision, dizziness, headache, and sedation.  This drug is not recommended for children under 12 years old and used with caution in the elderly.  Rare side effects include acute angle glaucoma, confusion, contact dermatitis, and urinary retention.
  • Intranasal scopolamine – It has been of particular interest in recent studies conducted by NASA and the Naval Aerospace Medical Research Laboratory, to indicate the significant discomfort of space motion sickness in astronauts and the airforce.  The nasal gel formulation of scopolamine has been found to have a more rapid absorption and repeatedly acting and onset of action than its transdermal or oral counterparts, with a more predictable efficacy and favorable side effect profile.

Antihistamines

H1 receptor antagonists decrease the firing of afferent nerves of the semicircular canals that are triggered by the histaminergic receptors system in the brain hypothalamus. Unfortunately, H1 antagonists are highly sedating in nature. Studies have determined the less sedating comparing second-generation antihistamines to be ineffective in treating motion sickness, likely due to mediation into peripheral versus central receptors.

  • Diphenhydramine – It is the first-generation antihistamine that also has anticholinergic properties.  It is also available in oral over-the-counter and injectable preparations.  Sedation is the main side effect common.  Other common side effects include dry mouth, eyes, blurred vision, and photosensitivity, etc.  Confusion and urinary retention may occur rarely.
  • Cyclizine – First-generation antihistamine available orally over the counter medication.  It has shown similar efficacy to diphenhydramine as well, but with less sedation and more direct action on the stomach absorption in treating gastrointestinal symptoms.  It is FDA-approved for adults and children over 6 years old.
  • Meclizine – First-generation antihistamines are available orally over the counter.  They are approved for patients 12 years and older but are highly sedating action.
  • Cinnarizine – The first-generation antihistamine with higher efficacy and action in treating motion sickness symptoms frequently with the least amount of drowsiness.  This drug is not available in the USA or Canada to avoid its calcium channel blocking properties but it is still widely used in Mexico and Europe and another country.
  • Promethazine – It is a first-generation antihistamine with anticholinergic properties.  It is prescription among, available in oral, rectal, and intramuscular preparations.  Promethazine has also been studied for treatment in space motion sickness, where intramuscular injections are commonly used.  Some scientific studies suggest, its side effects may impair operational performance. Combination therapy with caffeine has proven more effective in counteracting some side effects of promethazine as well.

Sympathomimetic

  • Dextroamphetamine – It has been shown to act synergistically with anticholinergics and antihistamines action by stimulating the dopaminergic and noradrenergic pathways pathway in the brain. Studies have proved that dextroamphetamine and scopolamine to be the most effective in the treatment of anti-motion sickness combination as they act through different pathways and their respective side effects are less. However, the risk of drug dependence has to be a consideration.  The use of sympathomimetic drugs for motion sickness is mainly during space flights.

Therapies Not Recommended

  • Metoclopramide – Dopamine antagonists such as metoclopramide have not consistently demonstrated efficacy in the treatment of motion sickness.  Although metoclopramide is an effective antiemetic and promotes gastric emptying function, studies have not demonstrated efficacy in the treatment of motion sickness still now.
  • Ondansetron(Bd drugs brand name Anset 4mg and 8mg) – Serotonin (5-HT3) receptor antagonists SUCH AS ondansetron are potent antiemetics and inhibit gastric tachyarrhythmia but are not effective in preventing motion sickness symptoms. Available dosage strength is 4mg, 8mg. Taking time before half an hour or 30 minutes of start journey.
  • Granisetron – Granisetron is an indazole derivative with antiemetic properties. As a selective serotonin receptor antagonist, granisetron competitively blocks the action of serotonin at 5-hydroxytryptamine3 (5-HT3) receptors, resulting in the suppression of chemotherapy- and radiotherapy-induced nausea and vomiting. Granisetron is a Serotonin-3 Receptor Antagonist. The mechanism of action of granisetron is as a Serotonin 3 Receptor Antagonist. Available dosage strength 1mg, 2mg 10mg. Taking time before half an hour or 30 minutes of start journey.
  • Hyoscine hydrobromide (Bd drugs brand name Joytrip 150 and 300mg) – It is mainly used to prevent travel sickness. The most common side effects are a dry mouth, constipation, and blurred vision. The travel sickness tablets come in different strengths: 300 micrograms for adults, 150 micrograms for children. Taking time before half an hour or 30 minutes of start journey.

Medications For Pregnant Patients

Pregnant women may have increased susceptibility to motion sickness. Medications used for morning sickness are felt to be safe for use in motion sickness, including meclizine and dimenhydrinate.  The FDA classifies these as category B in pregnancy.  Scopolamine and promethazine are Class C in pregnancy.

Home Remedies

The specific symptoms of motion sickness usually stop when the motion causing it ceases as normally. But this is not always true in most cases. There are people who suffer symptoms for even a few days after the trip or journey is over. Most people who have goes under motion sickness in the past ask their doctor how to prevent it next time. The following remedies may help by taking and boosting immunity.

  • Looking at the horizon – One common suggestion is to simply look out of the window of the moving vehicle and to gaze toward the horizon in the direction of travel. This helps to re-orient the inner sense of balance by providing a visual re-confirmation of motion.
  • Keeping eyes closed and napping – In the night or in a ship without windows, it is helpful to simply close one’s eyes, or if possible, take a nap properly. This resolves the input internal conflict between the eyes and the inner ear.
  • Chewing – Chewing gum is a simple way of reducing motion sickness in some cases. It is a simple method for relieving common and mild car sickness is chewing. Chewing gum has healthy effectiveness for reducing car sickness in those affected. A variety of chewing gum is available for purchase online. Chewing gum, however, is not the only thing one may chew to relieve mild effects of car sickness, snacking on sweets, or just chewing, in general, seems to reduce adverse effects of the conflict between vision and balance.
  • Fresh air – Fresh, cool air can also relieve motion sickness slightly, although it is likely this is related to avoiding foul odors, which can worsen nausea.
  • Ginger – Ginger has been found to reduce motion sickness. This is available in tablet form, or a fresh stem of ginger can be chewed to relieve symptoms. There is the case there has some debate over whether it is chewing or ginger that helps. Ginger products for motion sickness are available for purchase online on amazon.
  • Acupressure – An acupressure practitioner works with the same points used in acupuncture, but stimulates these healing sites with finger pressure, rather than inserting fine needles. Some studies suggest that acupressure may help reduce symptoms of motion sickness in the same way as acupuncture, although the scientific evidence is not clear.
  • Raw ginger – There’s some scientific proof that this root, long used as a folk remedy to fight nausea – vomiting, is effective. But it may act as a blood thinner.
  • Mint – Eating peppermint is also thought to calm the body. At the very least, the aroma may soothe you.

How can I prevent motion sickness?

These actions can lower your chances of getting sick or ease symptoms if they occur:

  • Herbs – Breath in soothing mint, ginger, or lavender scents. Suck on hard candies made with peppermint or ginger.
  • Diet and drink – Drink plenty of water. Choose low-fat, bland, starchy foods before traveling. Avoid heavy meals and greasy, spicy, or acidic foods that can upset your stomach. Don’t drink alcohol or smoke.
  • Fresh air – Direct air vents to blow toward you. And roll down windows in cars.
  • Distant gaze – Put down the phone, tablet, or book. Instead, look at an object in the distance or at the horizon.
  • Lie back – Recline, if possible, and close your eyes.
  • Pressure points – Wear acupressure wristbands.
  • Boat – Sit in the middle of the boat on the upper deck.
  • Bus – Choose a window seat.
  • Car – Sit in the front passenger seat.
  • Cruise ship – Book a cabin toward the front or middle of the ship. If you can, choose one on a lower level, closer to the water.
  • Plane – Sit in the wing section.
  • Train – Choose a forward-facing window seat.
  • Take motion sickness medicine one to two hours before traveling.
  • These seats have fewer bumps. They allow you to see the horizon. If you are on a cruise, book a cabin in the front or middle of the ship. Request a room that is closest to the water level.
  • Get plenty of air. Use the air conditioner or roll down the window in a car. Direct the vent toward you on a plane. Sit near a window when you’re on a covered boat.
  • Avoid things you can’t change. For example, don’t ride on a speed boat. Waves and bumps can make you sick. If you can’t avoid it, take medicine in advance.
  • Don’t read while riding in a car, plane or boat. Look out the window at the horizon. Look at a distant object.
  • Lie down when you feel sick.
  • Avoid a heavy meal before or during travel. Eat small portions of plain food instead. Don’t eat greasy, spicy, or acidic foods before or during travel.
  • Drink lots of water. Avoid alcohol.
  • Avoid smells that make you sick (if you can). This includes cigarette smoke.
  • Talk to your doctor about different therapies. This might include pressure bands (worn on your wrist).

If your symptoms last longer than a few days, see your doctor.

References

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