Motion sickness

Motion sickness is a common condition provoked by physical motion or visual motion.

Characterised by nausea/vomiting, possibly accompanied by other symptoms such as dizziness, vertigo, or headache.

Controlled breathing might be helpful to counteract symptoms of motion sickness.

Drug therapy includes antimuscarinics and antihistamines; however both may have significant adverse effects (notably drowsiness) and impede habituation (desensitisation).

Habituation and cognitive behavioural therapy may be useful for people who must undergo repeated provocative motion (e.g., occupational exposures).

Motion sickness is characterised by stomach discomfort, nausea, and vomiting, accompanied by dizziness, vertigo, or autonomic features such as pallor, clamminess, flushing, or sweating. These symptoms could also be associated with drowsiness, fatigue, or difficulty with concentration, which may be categorised as ‘alteration in arousal’.[1]Cha YH, Golding JF, Keshavarz B, et al. Motion sickness diagnostic criteria: consensus document of the Classification Committee of the Bárány Society. J Vestib Res. 2021;31(5):327-44. https://content.iospress.com/articles/journal-of-vestibular-research/ves200005 http://www.ncbi.nlm.nih.gov/pubmed/33646187?tool=bestpractice.com ​ The intensity of symptoms in response to physical or visual motion stimuli can vary greatly depending on age, level of adaptation, or other medical conditions. Once a certain level of nausea is attained, it may lead to vomiting even if the patient is removed from the motion environment (avalanche phenomenon).​[1]Cha YH, Golding JF, Keshavarz B, et al. Motion sickness diagnostic criteria: consensus document of the Classification Committee of the Bárány Society. J Vestib Res. 2021;31(5):327-44. https://content.iospress.com/articles/journal-of-vestibular-research/ves200005 http://www.ncbi.nlm.nih.gov/pubmed/33646187?tool=bestpractice.com [2]Reason JT, Graybiel A. Changes in subjective estimates of well-being during the onset and remission of motion sickness symptomatology in the slow rotation room. Aerosp Med. 1970 Feb;41(2):166-71.​​

Motion sickness refers to when the sickness-inducing stimulus is the physical motion of the person, while the term ‘visually induced motion sickness’ is used when visual motion is the primary provoking factor. These are separate diagnoses.[1]Cha YH, Golding JF, Keshavarz B, et al. Motion sickness diagnostic criteria: consensus document of the Classification Committee of the Bárány Society. J Vestib Res. 2021;31(5):327-44. https://content.iospress.com/articles/journal-of-vestibular-research/ves200005 http://www.ncbi.nlm.nih.gov/pubmed/33646187?tool=bestpractice.com ​ The rate at which motion sickness develops varies with the intensity of motion. Nausea leading to vomiting may develop within a few minutes if the provocative motion stimulus is intense, whereas with moderately provocative motion the onset of nausea is delayed, and vomiting may not necessarily occur. If motion is sustained, as on a long sea voyage, most people develop some habituation and become less susceptible to motion sickness. Similarly, frequent short exposures to provocative motion lead to a protective habituation, although the ability to adapt is marked by substantial individual differences. With infrequent exposures the protective value of habituating experiences is lost, and the patient returns to baseline levels of susceptibility.[3]Hu S, Grant WF, Stern RM, et al. Motion sickness severity and physiological correlates during repeated exposures to a rotating optokinetic drum. Aviat Space Environ Med. 1991;62:308-314. http://www.ncbi.nlm.nih.gov/pubmed/2031631?tool=bestpractice.com