Motion sickness

Encyclopedia of Medicine by Beth A. Kapes

Definition

Motion sickness is the uncomfortable dizziness, nausea, and vomiting that people experience when their sense of balance and equilibrium is disturbed by constant motion. Riding in a car, aboard a ship or boat, or riding on a swing all cause stimulation of the vestibular system and visual stimulation that often leads to discomfort. While motion sickness can be bothersome, it is not a serious illness, and can be prevented.

Description

Motion sickness is a common problem with nearly 80% of the population enduring its affects at one time in their lives. While it may occur at any age, motion sickness most often afflicts children over the age of two, with the majority outgrowing this susceptibility.

When looking at why motion sickness occurs, it is helpful to understand the role of the sensory organs. The sensory organs control a body's sense of balance by telling the brain what direction the body is pointing, the direction it is moving, and if it is standing still or turning. These messages are relayed by the inner ears (or labyrinth); the eyes; the skin pressure receptors, such as in those in the feet; the muscle and joint sensory receptors, which track what body parts are moving; and the central nervous system (the brain and spinal cord), which is responsible for processing all incoming sensory information.

Motion sickness and its symptoms surface when conflicting messages are sent to the central nervous system. An example of this is reading a book in the back seat of a moving car. The inner ears and skin receptors sense the motion, but the eyes register only the stationary pages of the book. This conflicting information may cause the usual motion sickness symptoms of dizziness, nausea and vomiting.

Causes & symptoms

While all five of the body's sensory organs contribute to motion sickness, excess stimulation to the vestibular system within the inner ear (the body's "balance center") has been shown to be one of the primary reasons for this condition. Balance problems, or vertigo, are caused by a conflict between what is seen and how the inner ear perceives it, leading to confusion in the brain. This confusion may result in higher heart rates, rapid breathing, nausea and sweating, along with dizziness and vomiting.

Pure optokinetic motion sickness is caused solely by visual stimuli, or what is seen. The optokinetic system is the reflex that allow the eyes to move when an object moves. Many people suffer when what they view is rotating or swaying, even if they are standing still.

Additional factors that may contribute to the occurrence of motion sickness include:

• Poor ventilation.
• Anxiety or fear. Both have been found to lower a person's threshold for experiencing motion sickness symptoms.
• Food. It is recommended that a heavy meal of spicy and greasy foods be avoided before and during a trip.
• Alcohol. A drink is often thought to help calm the nerves, but in this case it could upset the stomach further. A hangover for the next morning's trip may also lead to motion sickness.
• Genetic predisposition. Research suggests that some people are predisposed to motion sickness symptoms partly due to a hereditary link.

Often viewed as a minor annoyance, some travelers are temporarily immobilized by motion sickness, and a few continue to feel its effects for hours and even days after a trip (the "mal d'embarquement" syndrome).

Diagnosis

Most cases of motion sickness are mild and self-treatable disorders. If symptoms such as dizziness become chronic, a doctor may be able to help alleviate the discomfort by looking further into a patient's general health. Questions regarding medications, head injuries, recent infections, and other questions about the ear and neurological system will be asked. An examination of the ears, nose, and throat, as well as tests of nerve and balance function, may also be completed.

Severe cases of motion sickness symptoms, and those that become progressively worse, may require additional, specific tests. Diagnosis in these situations deserves the attention and care of a doctor with specialized skills in diseases of the ear, nose, throat, equilibrium, and neurological system.

Treatment

There are a variety of medications to help ease the symptoms of motion sickness, and most of these are available without a prescription. Known as over-the-counter (OTC) medications, it is recommended that these be taken 30-60 minutes before traveling to prevent motion sickness symptoms, as well as during an extended trip.

Drugs

The following OTC drugs consist of ingredients that have been considered safe and effective for the treatment of motion sickness by the Food and Drug Administration:

• Marezine (and others). Includes the active ingredient cyclizine and is not for use in children under age 6.
• Benadryl (and others). Includes the active ingredient diphenhydramine and is not for use in children under age 6.
• Dramamine (and others). Includes the active ingredient dimenhydrinate and is not for use in children under age 2.
• Bonine (and others). Includes the active ingredient meclizine and is not for use in children under age 12.

Each of the active ingredients listed above are antihistamines whose main side effect is drowsiness. Caution should be used when driving a vehicle or operating machinery, and alcohol should be avoided when taking any drug for motion sickness. Large doses of OTC drugs for motion sickness may also cause dry mouth and occasional blurred vision.

The Food and Drug Administration recommends that people with emphysema, chronic bronchitis, glaucoma, or difficulty urinating due to an enlarged prostate do not use OTC drugs for motion sickness unless directed by their doctor.

Longer trips may require a prescription medication called scopolamine (Transderm Scop). Formerly used in the transdermal skin patch (now discontinued), travelers must now ask their doctor to prescribe it in the form of a gel. In gel form, scopolamine is most effective when smeared on the arm or neck and covered with a bandage.

Alternative treatment

Alternative treatments for motion sickness have become widely accepted as a standard means of care. Ginger (Zingiber officinale) in its various forms is often used to calm the stomach, and it is now known that the oils it contains (gingerols and shogaols) appear to relax the intestinal tract in addition to mildly depressing the central nervous system. Some of the most effective forms of ginger include the powdered, encapsulated form; ginger tea prepared from sliced ginger root; or candied pieces. All forms of ginger should be taken on an empty stomach.