What non‑pharmacologic strategies can be used to prevent or reduce motion sickness?

Non-Pharmacologic Management of Motion Sickness

The most effective non-pharmacologic strategies for motion sickness are behavioral positioning techniques and controlled exposure for habituation, with emerging evidence supporting specific nutritional interventions and acupuncture-based therapies. 1

Behavioral and Positioning Strategies

Position yourself in the most stable part of the vehicle and maintain visual fixation on the true horizon to minimize sensory conflict. 1 This works by reducing the mismatch between vestibular and visual inputs that triggers motion sickness. 2

Specific positioning recommendations:

• Watch the true visual horizon continuously during travel 1
• Steer or drive the vehicle when possible, as active control reduces symptoms 1
• Tilt your head into turns to align vestibular signals with motion 1
• Lie down with eyes closed when symptoms begin 1
• Sit in the front seat of cars or over the wing in aircraft, where motion is least pronounced 1

Exposure and habituation:

• Slow, intermittent exposure to the provocative motion reduces symptoms over time 1
• Systematic adaptation procedures that reduce velocity storage of semicircular canal signals (the key physiological mechanism) can increase resistance to motion sickness 3
• Habituation through prolonged exposure is effective but requires repeated sessions 2

Autonomic Nervous System Modulation

Activation of the parasympathetic nervous system through diaphragmatic breathing and pleasant music can alleviate motion sickness symptoms. 4 This approach directly counteracts the autonomic dysregulation that produces nausea and vomiting.

Specific techniques:

• Practice slow, deep diaphragmatic breathing to shift autonomic balance 4
• Listen to pleasant, calming music during travel 4

Nutritional and Herbal Interventions

Specific micronutrients including ginger (gingerol), hesperidin, menthol, and vitamin C have demonstrated positive effects on motion sickness symptoms. 4

Evidence-based nutritional options:

• Ginger root preparations contain gingerol, which has anti-nausea properties 4
• Hesperidin (a citrus bioflavonoid) shows benefit 4
• Menthol can reduce symptoms 4
• Vitamin C supplementation may help 4
• Herbal formulations such as Tianxian and Tamzin have been shown to be as effective as medications 4

Important caveat: Macronutrient effects are complex and influenced by food matrix and composition, so avoid heavy meals before travel. 4

Acupuncture and Acupressure

Electroacupuncture administered by competent practitioners reduces acute vomiting episodes, though evidence for nausea reduction is weaker. 5 A meta-analysis of 1,247 patients showed that acupuncture-point stimulation reduced acute emesis (RR 0.82; 95% CI 0.69-0.99; P=0.04). 5

Specific modalities:

• Electroacupuncture is most effective (RR 0.76; 95% CI 0.60-0.97; P=0.02), reducing vomiting episodes significantly 5
• Manual acupuncture with needles reduces acute vomiting (RR 0.74; 95% CI 0.58-0.94; P=0.01) but not nausea severity 5
• Acupressure (pressure without needles) reduces acute nausea severity but not vomiting 5
• Noninvasive electrostimulation was not beneficial 5

Critical limitation: Competency in acupuncture techniques is variable and difficult to assess, and electroacupuncture is not readily available in all geographic areas. 5

Environmental and Lifestyle Modifications

Minimize other sources of physical, mental, and emotional discomfort before and during travel. 1

Specific recommendations:

• Avoid reading or focusing on near objects during motion 1
• Ensure adequate sleep before travel, as sleep deprivation enhances susceptibility 3
• Reduce exposure to unpleasant odors, heat, and poor ventilation 1
• Avoid alcohol and excessive caffeine before travel 1

Early Recognition and Self-Diagnosis

Learn to identify early warning signs—stomach awareness, malaise, drowsiness, and irritability—which precede nausea, allowing earlier intervention. 1 Many cases of motion sickness go unrecognized because people focus only on nausea and vomiting as defining symptoms. 3

Common Pitfalls to Avoid

• Do not rely solely on non-sedating antihistamines or ondansetron, as these are ineffective for motion sickness prevention 1
• Avoid situations with maximum sensory conflict (e.g., reading in a moving vehicle, sitting in rear seats) 1
• Do not expect immediate habituation—adaptation requires repeated, gradual exposure 2
• Recognize that individual susceptibility varies 10,000-fold in the normal population, so strategies must be tailored to severity 3

Special Populations

• Children aged 2-12 years are most susceptible and benefit most from behavioral positioning strategies 6
• Women, particularly during menstruation or pregnancy, have increased susceptibility and should emphasize non-pharmacologic approaches 6
• Individuals with migraines or vestibular asymmetry are predisposed and require more aggressive preventive strategies 6