What is the treatment for motion sickness?

Treatment for Motion Sickness

First-generation antihistamines such as dimenhydrinate are the first-line pharmacological treatment for motion sickness prevention and treatment. 1, 2

Pharmacological Management

First-line Medications

• Dimenhydrinate: FDA-approved for prevention and treatment of nausea, vomiting, or vertigo of motion sickness 1

  • Should be taken 30-60 minutes before anticipated motion exposure
  • May cause sedation as a side effect (66% vs 44% with placebo) 3

• Scopolamine (transdermal):

  • Apply patch behind the ear several hours (6-8 hours) before anticipated motion exposure 2, 4
  • As effective as dimenhydrinate in preventing motion sickness symptoms 4
  • Must be applied well in advance to be effective

Second-line Medications

• Other first-generation antihistamines (e.g., meclizine, cyclizine) 3
  • Moderate certainty evidence shows antihistamines are more effective than placebo at preventing motion sickness symptoms (40% vs 25%) 3

Ineffective Medications

• Non-sedating antihistamines: Not effective for motion sickness 2
• Ondansetron: Not effective for preventing motion sickness, even in high doses 5, 2
• Ginger root: Lacks evidence of effectiveness 2

Non-Pharmacological Interventions

Behavioral Strategies

1. Positioning:

   • Choose the most stable part of the vehicle (middle of boat, over wings in airplane)
   • Face forward in the direction of travel
   • Keep head stabilized against a headrest

2. Visual Techniques:

   • Focus on the distant horizon or a fixed point
   • Avoid reading or looking at screens
   • If possible, take control of the vehicle (steering)

3. Head and Body Positioning:

   • Tilt head into turns when in a vehicle
   • Lie down with eyes closed if symptoms worsen
   • Minimize head movements

4. Gradual Exposure:

   • Slow, intermittent exposure to motion can reduce sensitivity over time

Treatment Algorithm

1. Prevention (First Choice):

   • Dimenhydrinate 50-100 mg orally 30-60 minutes before travel 1, 2
   • OR Scopolamine transdermal patch applied 6-8 hours before travel 2, 4

2. If symptoms occur despite prevention:

   • Take additional dose of dimenhydrinate if 6+ hours have passed since last dose
   • Implement behavioral strategies (focus on horizon, minimize head movement)
   • Lie down if possible with eyes closed

3. For severe symptoms:

   • Consider intramuscular administration of antihistamines if available 6
   • Ephedrine (25 mg IM) may help counteract some secondary symptoms like drowsiness 6

Important Considerations

• Sedation risk: First-generation antihistamines cause significant sedation (66% vs 44% with placebo) 3
• Timing is crucial: Medications should be taken before symptoms begin, as they're more effective for prevention than treatment
• Physiological effects: Motion sickness can cause gastric tachyarrhythmia and slowing of brain waves, which may be counteracted by certain medications 6
• Duration: For prolonged travel, consider the duration of medication effect (dimenhydrinate typically lasts 4-6 hours)

Common Pitfalls to Avoid

• Waiting until symptoms begin: Motion sickness is much easier to prevent than to treat once symptoms have started
• Using ineffective treatments: Nonsedating antihistamines, ondansetron, and ginger are ineffective despite popular belief 2
• Overlooking behavioral strategies: Medication works best when combined with proper positioning and visual focusing techniques
• Not accounting for medication timing: Scopolamine patches must be applied 6-8 hours before travel to be effective 4