Recommended Waiting Period Between Flights for MDDS in Near-Remission
Given your near-remission status from MDDS, I recommend waiting a minimum of 72 hours (3 days) between your 12-hour and 2-hour flights, with strong consideration for extending this to 96 hours (4 days) if logistically feasible.
Rationale for the 72-96 Hour Window
The Bárány Society's 48-hour criterion defines when symptoms occurring after motion exposure can be classified as MDDS, but this does not directly translate to a safe re-exposure interval 1. The critical issue is that prolonged travel by air on the way home has been identified as a major contributor to symptomatic reversion after successful treatment 1.
Key Evidence Supporting Extended Intervals:
Treatment outcomes worsen with repeated motion exposure: Studies demonstrate that patients who underwent successful MDDS treatment experienced symptomatic reversion when they had prolonged air or car travel shortly after treatment, suggesting that cumulative motion exposure within a compressed timeframe is problematic 1.
Duration matters more than frequency: The research shows that treatment success is inversely correlated with symptom duration and that early intervention prevents chronicity 1. Your near-remission status is protective, but re-triggering could restart the maladaptive vestibulo-ocular reflex cycle 2.
The 48-hour window is diagnostic, not therapeutic: The Bárány criterion identifies when symptoms constitute MDDS, but doesn't establish when it's safe to re-expose yourself to motion triggers 1, 3.
Your Specific Mitigation Strategy
Your planned approach is reasonable but requires optimization:
Medication Timing and Dosing:
Lorazepam 0.5mg every 8 hours: This is appropriate, as benzodiazepines have shown the most benefit for MDDS symptoms 4. However, consider starting this regimen 24 hours before your first flight rather than at departure, as prophylaxis may be more effective than reactive treatment.
Cinnarizine 20mg one hour before flight: This vestibular suppressant timing is appropriate for the flight itself, but note that traditional vestibular suppressants like meclizine have shown limited efficacy in established MDDS 4. Cinnarizine may be more useful for preventing acute motion sickness during the flight rather than MDDS recurrence.
Critical Behavioral Modifications:
Walking for the first 3 days post-arrival: This is excellent and evidence-based. Physical activity and vestibular rehabilitation have shown benefit, though modest, in MDDS management 4. Continue this throughout your entire trip, not just the first 3 days.
Avoid alcohol completely: Alcohol should be avoided before and during both flights, as it can worsen vestibular symptoms and increase MDDS susceptibility 5.
Minimize visual-vestibular conflict: During flights, avoid reading or screen time during takeoff, landing, and turbulence. Keep your gaze fixed on the horizon or a stable distant point when possible 2.
The 3-4 Day Interval Decision Algorithm:
Choose 72 hours (3 days) if:
- Your MDDS symptoms have been completely absent for >6 months
- You have no history of symptom recurrence with previous air travel
- The connecting flight is essential and cannot be rescheduled
Choose 96 hours (4 days) if:
- You've had any MDDS symptoms in the past 3-6 months
- You experienced symptom recurrence with previous travel
- You have flexibility in your schedule
- You're female in your 40s-50s (peak demographic for MDDS recurrence) 1, 3, 4
Additional Protective Measures:
Ground transportation between flights: If possible, use ground transportation (car, train) rather than a second flight. While this involves motion, it's typically less provocative than air travel and allows for breaks 1.
Vestibular migraine prophylaxis: If you have any personal or family history of migraines, consider discussing prophylactic migraine management with your physician, as 73% of MDDS patients responded well to vestibular migraine protocols including verapamil, nortriptyline, or topiramate 6.
Hydration and mobility during flights: Remain well-hydrated and mobile during the long-haul flight, performing leg exercises and walking when safe 5. However, avoid excessive walking if you feel vestibular symptoms emerging.
Common Pitfalls to Avoid:
Don't assume symptom-free means risk-free: Even in near-remission, the maladaptive vestibular response can be re-triggered 1, 2.
Don't rely solely on vestibular suppressants: Meclizine and scopolamine have poor efficacy for MDDS prevention 4. Your benzodiazepine is more appropriate.
Don't schedule tight connections: The stress of rushing between flights, combined with the motion exposure, creates a perfect storm for MDDS recurrence 1.
The 72-96 hour window balances the Bárány diagnostic criterion with the clinical reality that cumulative motion exposure within short timeframes increases recurrence risk, while your prophylactic medication and behavioral strategies provide additional protection.