What are the best ways to prevent and treat motion sickness?

Prevention and Treatment of Motion Sickness

Transdermal scopolamine is the most effective first-line medication for prevention of motion sickness and should be applied 4 hours before anticipated motion exposure. 1

Understanding Motion Sickness

Motion sickness occurs when there is conflicting information between the vestibular, visual, and proprioceptive systems. Common symptoms include:

• Initial symptoms: stomach awareness, malaise, drowsiness, irritability
• Progressive symptoms: nausea, vomiting, headache, dizziness
• Associated symptoms: increased salivation, burping, spatial disorientation, difficulty concentrating

Prevention Strategies

Behavioral Approaches (First-Line)

• Positioning:

  • Choose the most stable part of the vehicle (middle of aircraft, forward cabin on ships)
  • Face forward in the direction of travel
  • Avoid reading or focusing on fixed objects inside the vehicle

• Visual Strategies:

  • Focus on the true horizon when possible
  • If driving, take the wheel (being in control reduces symptoms)
  • Tilt head into turns during travel
  • If symptoms worsen, lie down and close eyes

• Habituation:

  • Gradual, intermittent exposure to motion can reduce susceptibility over time
  • Start with short trips and gradually increase duration

• Other Preventive Measures:

  • Avoid heavy meals, alcohol, and strong odors before and during travel
  • Ensure adequate ventilation
  • Minimize head movements during travel
  • Keep a daily symptom journal to track triggers 2

Pharmacological Prevention (When Behavioral Approaches Are Insufficient)

1. First-Line: Transdermal Scopolamine

   • Apply patch behind ear at least 4 hours before travel
   • Provides approximately 75% reduction in motion-induced nausea and vomiting 1
   • Duration: 3 days per patch
   • Side effects: dry mouth, drowsiness, blurred vision, confusion

2. Second-Line: First-Generation Antihistamines

   • Effective for prevention (RR 1.81,95% CI 1.23 to 2.66) 3
   • Options include:
     • Dimenhydrinate
     • Meclizine
     • Cinnarizine (where available)
   • Take 30-60 minutes before travel
   • Side effects: sedation (more common than with scopolamine)

3. Ineffective Treatments (avoid these):

   • Nonsedating antihistamines
   • Ondansetron (shown ineffective in studies) 4
   • Ginger root 5

Treatment Algorithm

1. For planned travel with history of motion sickness:

   • Apply transdermal scopolamine patch 4-16 hours before travel 1
   • If contraindicated, use first-generation antihistamines 30-60 minutes before travel

2. For unexpected motion sickness or breakthrough symptoms:

   • First-generation antihistamines can be used for treatment
   • Limit vestibular suppressants to short-term use (<1 week) to avoid interference with vestibular compensation 2

3. For severe nausea/vomiting during motion sickness:

   • Consider adding a prokinetic antiemetic like metoclopramide 10 mg 2

Special Considerations

• Air Travel: Low humidity in airplanes can cause ocular discomfort; consider artificial tears 6
• High Altitude Travel: May exacerbate symptoms; acetazolamide can be effective prophylactically 6
• Contraindications for Scopolamine: Known hypersensitivity, glaucoma, urinary retention, pregnancy 1
• Elderly Patients: Higher risk of falls and adverse effects from medications; consider lower doses

Important Cautions

• Vestibular suppressants should be limited to short-term use as they can interfere with natural vestibular compensation 2
• Sedating medications may impair ability to drive or operate machinery
• Motion sickness medications should be stored in childproof containers out of reach of children
• Withdrawal symptoms can occur after removing scopolamine patch after several days of use 1

Early recognition and prevention are key to managing motion sickness effectively. For most patients, a combination of behavioral strategies and appropriate medication when needed provides the best outcomes.