What are the treatment options for motion sickness (vehicle nausea) during travel?

Treatment of Motion Sickness During Travel

For motion sickness prevention during travel, apply scopolamine transdermal patch at least 4 hours before departure, which reduces motion-induced nausea and vomiting by 75% compared to placebo. 1

First-Line Pharmacological Prevention

Scopolamine transdermal system is the preferred first-line medication for motion sickness prevention and should be applied to a hairless area behind one ear at least 4 hours before anticipated motion exposure. 1, 2

• The patch delivers approximately 1 mg over 3 days and demonstrated a 75% reduction in motion-induced nausea and vomiting in clinical trials involving 195 adults exposed to sea or controlled motion environments. 1
• If treatment is needed beyond 3 days, remove the patch and apply a new one behind the opposite ear. 1
• Critical safety consideration: Wash hands immediately after application to prevent accidental eye contact, which can cause pupil dilation and blurred vision. 1

Alternative Pharmacological Options

First-generation antihistamines are effective alternatives, though they cause sedation. 2, 3

• Antihistamines are probably more effective than placebo at preventing motion sickness under natural conditions (40% prevention with antihistamines vs 25% with placebo; RR 1.81,95% CI 1.23 to 2.66). 3
• Specific agents include cinnarizine and dimenhydrinate, which have been studied under natural travel conditions. 3
• Important caveat: Antihistamines may increase sedation risk by 50% compared to placebo (66% vs 44%; RR 1.51,95% CI 1.12 to 2.02), but result in little difference in blurred vision or impaired cognition. 3

Ineffective Medications to Avoid

Nonsedating antihistamines, ondansetron, and ginger root are NOT effective for motion sickness prevention or treatment. 2

Behavioral Strategies (Adjunctive to Medication)

Patients should implement these strategies alongside pharmacological prevention: 2

• Positioning: Sit in the most stable part of the vehicle (front seat of car, middle of ship, over wings in aircraft). 2
• Visual strategies: Watch the true visual horizon, steer the vehicle if possible, or lie down with eyes closed. 2
• Gradual exposure: Slow, intermittent exposure to motion can reduce symptoms through adaptation. 2
• Head positioning: Tilt head into turns during travel. 2

Physiological Basis and Patient Counseling

Motion sickness results from conflict between vestibular, visual, and proprioceptive systems when the brain receives conflicting information about body movement. 2, 4

• Early recognition is critical: Nausea is often preceded by stomach awareness, malaise, drowsiness, and irritability—patients should recognize these prodromal symptoms and intervene immediately. 2
• High-risk populations: Children aged 2-12 years are most susceptible; women are more frequently affected than men, particularly during menstruation and pregnancy. 5
• Unique consideration: Individuals with complete bilateral vestibular loss will NOT experience motion sickness. 6

Adverse Effects and Withdrawal

Scopolamine can cause withdrawal symptoms 24+ hours after patch removal, including difficulty with balance, dizziness, nausea, vomiting, confusion, muscle weakness, low heart rate, or low blood pressure—particularly after several days of use. 1

Common side effects of scopolamine include: 1

• Dry mouth (most common)
• Dizziness and drowsiness
• Blurred vision or temporary pupil dilation
• Disorientation and irritability

Comparative Effectiveness

The evidence comparing antihistamines to scopolamine is very uncertain (symptoms prevented: 81% scopolamine vs 71% antihistamines; RR 0.89,95% CI 0.68 to 1.16), though both are more effective than placebo. 3

Special Situations

Cybersickness (motion sickness from virtual reality, video games, simulators) follows the same pathophysiology and treatment principles as traditional motion sickness, though exposure is increasingly common with modern technology. 6