What are the treatment options for motion sickness?

Treatment Options for Motion Sickness

For motion sickness prevention and treatment, first-line pharmacological therapy is scopolamine administered transdermally several hours before anticipated motion exposure, while first-generation antihistamines like dimenhydrinate are effective alternatives despite their sedating effects. 1

First-Line Pharmacological Options

Scopolamine

• Transdermal scopolamine is considered first-line therapy for prevention of motion sickness
• Should be applied several hours before anticipated motion exposure
• Mechanism: Central-acting anticholinergic that blocks muscarinic receptors
• Side effects: Blurred vision, dry mouth, dilated pupils, urinary retention, and sedation

First-Generation Antihistamines

• Dimenhydrinate is FDA-approved for prevention and treatment of nausea, vomiting, or vertigo of motion sickness 2
• Effective for preventing motion sickness symptoms under natural conditions (40% effectiveness vs. 25% with placebo) 3
• Side effects: Increased likelihood of sedation (66% vs. 44% with placebo) 3
• Dosing: Take 30-60 minutes before travel

Non-Pharmacological Strategies

Behavioral Techniques

• Position yourself in the most stable part of the vehicle (middle of boat, over wings in airplane)
• Focus on the true visual horizon when possible
• If driving is an option, take the wheel (being in control reduces symptoms)
• Tilt head into turns when in a moving vehicle
• Lie down with eyes closed if symptoms worsen
• Minimize head movements during motion

Environmental Modifications

• Ensure adequate ventilation
• Avoid strong odors
• Minimize reading or focusing on fixed objects inside the vehicle
• Reduce other sources of physical, mental, and emotional discomfort
• Gradual exposure to motion can help with habituation

Dietary Considerations

• Avoid heavy, greasy meals before travel
• Avoid alcohol consumption before and during travel
• Light, small meals may be better tolerated
• Stay hydrated but avoid excessive fluid intake

Ineffective Treatments

• Nonsedating (second-generation) antihistamines are not effective for motion sickness 1
• Ondansetron showed no benefit over placebo in preventing motion sickness in highly susceptible individuals 4
• Ginger root has not demonstrated consistent effectiveness for motion sickness prevention 1

Special Considerations

Medication Selection Algorithm

1. For short trips or when alertness is not critical: First-generation antihistamines (dimenhydrinate, meclizine)
2. For longer trips when alertness is needed: Transdermal scopolamine
3. For severe symptoms: Consider combination therapy with both medication classes, but be cautious of increased side effects

Cautions

• Benzodiazepines should be avoided due to risk of falls, especially in elderly patients, and potential for dependence 5
• Vestibular suppressants can delay proper vestibular compensation and increase drowsiness 5
• Anticholinergics should be used with caution in elderly patients and those with glaucoma, prostatic hypertrophy, or cardiac conditions

Treatment Timing

• Preventive medications should be taken 30-60 minutes before travel (oral medications) or several hours before (transdermal scopolamine)
• Once symptoms are severe, medications are less effective, emphasizing the importance of prevention

Motion sickness is a common condition that can be effectively managed with a combination of pharmacological and non-pharmacological approaches, with the choice of therapy depending on trip duration, need for alertness, and individual susceptibility.