What are the guidelines for treating motion sickness?

Guidelines for Motion Sickness Treatment

Scopolamine transdermal system is the first-line medication for prevention of motion sickness and should be administered transdermally several hours before anticipated motion exposure. 1

Pharmacological Management

First-Line Options:

• Transdermal scopolamine should be applied at least 4 hours before the activity to prevent nausea and vomiting associated with motion sickness 2
• Clinical studies have shown a 75% reduction in the incidence of motion-induced nausea and vomiting with scopolamine transdermal system 2
• For optimal effectiveness, apply the patch to a hairless area behind one ear 2

Second-Line Options:

• First-generation antihistamines are effective alternatives for motion sickness prevention 1, 3
• Antihistamines are probably more effective than placebo at preventing motion sickness symptoms under natural conditions (40% vs 25% prevention rate) 3
• Antihistamines may cause more sedation compared to placebo (66% vs 44%) 3

Ineffective Treatments:

• Nonsedating antihistamines, ondansetron, and ginger root are not effective in the prevention and treatment of motion sickness 1

Non-Pharmacological Strategies

Behavioral Approaches:

• Early self-diagnosis should be emphasized, and patients should be counseled about behavioral strategies before traveling 1
• Patients should position themselves in the most stable part of the vehicle to minimize exposure to unpleasant motion 1
• Slow, intermittent exposure to motion can help reduce symptoms 1

Visual and Positional Techniques:

• Watching the true visual horizon can help reduce symptoms 1
• Steering the vehicle, when possible, may reduce symptoms 1
• Tilting the head into turns or lying down with eyes closed can be beneficial 1
• Avoid focusing on moving objects or reading during travel 1

Special Considerations

Duration of Treatment:

• If treatment is needed for longer than 3 days, remove the scopolamine transdermal system and place a new one on the hairless area behind the other ear 2
• Prolonged use of vestibular suppressants like scopolamine can interfere with central compensation in peripheral vestibular conditions 4

Side Effects and Precautions:

• Scopolamine can cause significant adverse effects including blurred vision, dry mouth, dilated pupils, urinary retention, and sedation 4
• Antihistamines may cause sedation, which can impair activities requiring mental alertness 3
• After removing the scopolamine patch, wash hands and the area behind the ear thoroughly with soap and water 2

High-Risk Populations:

• Children between 2 and 12 years old are most susceptible to motion sickness 5
• Women are more frequently affected than men 5
• Predisposing factors include menstruation, pregnancy, migraines 5
• Anticholinergic medications are a significant independent risk factor for falls, especially in elderly patients 4

Prevention of Anticipatory Symptoms

• The best approach to prevent anticipatory nausea and vomiting is optimal control of acute symptoms 6
• Behavioral therapies such as progressive muscle relaxation training, systematic desensitization, and hypnosis can effectively treat anticipatory symptoms 6
• Benzodiazepines can reduce anticipatory symptoms, but their efficacy tends to decrease with continued use 6

Treatment Algorithm

1. Start with transdermal scopolamine applied 4 hours before travel 2
2. If scopolamine is contraindicated or unavailable, use first-generation antihistamines 1, 3
3. Implement behavioral strategies regardless of medication use 1
4. For prolonged travel (>3 days), rotate scopolamine patch to opposite ear 2
5. For breakthrough symptoms, focus on behavioral techniques like focusing on the horizon and positioning in stable parts of the vehicle 1