What are the treatment options for motion sickness?

Motion Sickness Treatment Options

The first-line treatments for motion sickness are antihistamines and scopolamine, with behavioral strategies playing an important supportive role in prevention and management. 1, 2

Pharmacological Treatment Options

First-Line Medications

• Scopolamine (transdermal): FDA-approved for motion sickness prevention with demonstrated 75% reduction in motion-induced nausea and vomiting when applied 4-16 hours before travel 3
• First-generation antihistamines: Probably more effective than placebo at preventing motion sickness symptoms under natural conditions (40% vs 25% prevention rate) 1
  • Dimenhydrinate is effective against experimentally-induced motion sickness 4
  • Meclizine is commonly used for peripheral vertigo and motion sickness symptoms 5

Second-Line Options

• Antiemetics: Prokinetic antiemetics such as metoclopramide can be useful adjuncts for managing nausea and vomiting associated with motion sickness 6
• Prochlorperazine: May be used for short-term management of severe nausea or vomiting in patients with motion sickness who are severely symptomatic 7, 5

Medications to Avoid

• Nonsedating antihistamines: Not effective for prevention and treatment of motion sickness 2
• Ondansetron: Not effective for prevention and treatment of motion sickness 2
• Ginger root: Not effective for prevention and treatment of motion sickness despite popular belief 2

Behavioral Strategies

• Positioning: Sit in the most stable part of the vehicle (front seat in cars, middle of boat, over wings in aircraft) 2
• Visual focus: Watch the true visual horizon to reduce sensory conflict 2
• Head position: Minimize head movements and tilt head into turns when possible 2
• Controlled exposure: Slow, intermittent exposure to motion can reduce symptoms through habituation 2
• Activity: When possible, be the driver/pilot of the vehicle rather than a passenger 2
• Rest: Lying down with eyes closed can help reduce sensory conflict 2

Comparative Effectiveness

• Scopolamine vs. Antihistamines: Evidence is uncertain about comparative effectiveness (81% prevention with scopolamine vs. 71% with antihistamines) 1
• Side Effect Profiles:
  • Antihistamines may cause more sedation than placebo (66% vs. 44%) 1
  • Scopolamine may cause less sedation than antihistamines in some studies 4
  • Both medications have minimal effects on blurred vision and cognitive impairment 1

Special Considerations

• Timing: Preventive medications should be taken before exposure to motion:

  • Scopolamine patch: Apply 4-16 hours before travel 3
  • Antihistamines: Take 30-60 minutes before travel 1, 2

• Duration: Vestibular suppressant medications should be used for short-term management rather than long-term treatment 7, 5

• Age factors: Children between 2-12 years are most susceptible to motion sickness 8

• Gender differences: Women are more frequently affected than men 8

• Predisposing factors: Menstruation, pregnancy, and history of migraines may increase susceptibility 8

Treatment Algorithm

1. Prevention (first choice): Apply transdermal scopolamine patch 4-16 hours before travel 3, 2
2. Prevention (alternative): Take first-generation antihistamine (meclizine or dimenhydrinate) 30-60 minutes before travel 1, 2
3. During motion sickness: Implement behavioral strategies (proper positioning, visual focusing, minimizing head movements) 2
4. For severe symptoms: Consider prochlorperazine for short-term management of severe nausea/vomiting 7, 5
5. For prolonged exposure: Consider alternating medications to prevent tolerance while implementing habituation techniques 2, 8

Pitfalls and Caveats

• Long-term use of vestibular suppressant medications can interfere with natural adaptation to motion 5
• Medications primarily treat symptoms rather than addressing the underlying sensory conflict 7
• First-generation antihistamines and scopolamine can cause significant drowsiness, which may impair driving or operating machinery 1, 2
• "Cybersickness" from virtual reality and video games is a growing form of motion sickness that responds to similar treatments 9