Motion Sickness Treatments: A Complete Guide for Travelers

Are you planning an exciting sea adventure, but worried about sea sickness or motion sickness ruining the experience? Look no further! Nusa Medica Clinic has the perfect solution for you! This article will explore the causes and symptoms of motion sickness, management strategies, and the treatment options available to people who suffer from this condition.

Motion sickness is caused by a conflict between the sensory input from the eyes, ears and muscles​. The vestibular system, located in the inner ear, plays a critical role in maintaining balance and spatial orientation ​[1]​. When there is a discrepancy between the information received by the eyes and the inner ear, the brain interprets this as motion and triggers a response that can lead to nausea, vomiting, and other symptoms. An example of this would be a person reading while travelling in a car — their eyes see the stationary book, yet the vestibular system detects the motion of the car​ [2]​. It is commonly encountered in travel by car, sea, and air, and also experienced as a result of immersive virtual reality​.

Seasickness is a common condition that affects many people when they are on boats or ships. It occurs because of the motion of the water, which can confuse the brain. When you are on a boat, your inner ear senses movement, but your eyes may not see it, especially if you are reading or looking inside the cabin.

Clinical Presentation

The primary symptoms of motion sickness are nausea and vomiting. Related symptoms (Table 1) include drowsiness (sometimes termed "sopite syndrome"), gastrointestinal discomfort, increased salivation, sensations of bodily warmth, dizziness, and facial pallor and sweating (so-called cold sweating). The onset of seasickness is usually gradual, the timescale being determined by the stimulus's intensity and the individual's susceptibility. Failure to attribute early symptoms to seasickness may lead to delays in diagnosis and treatment. Although mild symptoms are common, severely debilitating symptoms are rare. (Brainard & Gresham, 2014). (Table 1).

Management strategies and Motion Sickness Treatments options

Prevention

Prevention of motion sickness is more effective than treating symptoms after they have occurred. Therefore, patients should learn to identify situations that may lead to motion sickness and be able to initiate behavioral strategies to prevent or minimize symptoms. ​[3]​.

A. Behavioral Management

Behavioral countermeasures against seasickness are among the most effective treatments. Habituation is the most effective long-term countermeasure. It lacks the adverse effects of pharmacotherapy, such as drowsiness and blurred vision. Short-term maneuvers include:

• Body postural changes: reducing head movements, restraining movement of the head, shoulders, hips, and knees
• Avoiding reading in moving vehicles
• Sitting in a forward-facing seat, a front seat, or actively steering the vehicle
• Focusing on a stable horizon
• Controlled, mindful breathing
• Avoiding nicotine (if the patient is a smoker)
• Listening to pleasant music
• Avoiding travel in turbulent conditions or with poor visibility

B. Medications

Medications are most effective when taken prophylactically before traveling, or as soon as possible after the onset of symptoms rather than after the onset of symptoms. Medications are also effective when combined with behavioral strategies​ [2]​. All medications used to treat seasickness have side effects and may have specific medical contraindications. The most common side effect is drowsiness or sedation ​[4]. Medications can be subdivided into categories: anticholinergic, antihistamine, and sympathomimetic.

• Anticholinergic

Scopolamine is a first-line option for preventing motion sickness in persons who wish to maintain wakefulness during travel. Scopolamine has less sedation than antihistamines.  It is available as a transdermal patch. The patch should be applied to the mastoid at least 4 hours before travel, with effects lasting for 72 hours. The transdermal patch should never be cut up in mistaken attempts to vary the dose, since this disrupts the mechanism of release [4]. Common side effects include dry eyes/mouth, photosensitivity, blurred vision, dizziness, headache, and sedation.  This medicine is not recommended for children under 12 years old and used with caution in the elderly.  Rare side effects include acute angle glaucoma, confusion, contact dermatitis, and urinary retention [3].

• Antihistamine

First-generation antihistamines have been used to treat motion sickness since the 1940s [1]. They are generally recommended for patients who can tolerate their sedative effects. Cyclizine (Marezine), dimenhydrinate, promethazine, and meclizine (Antivert) demonstrated effectiveness in small RCTs of varying quality. Nonsedating antihistamines are not effective in preventing or treating motion sickness [3].

• Diphenhydramine: It is available in oral (over-the-counter) and injectable preparations.  Sedation is common.  Other common side effects include dry mouth/eyes, blurred vision, and photosensitivity.  Confusion and urinary retention occur rarely.
• Cyclizine: It is available orally over the counter.  It has shown similar efficacy to diphenhydramine, but with slightly less sedation and more direct action on the stomach in treating gastrointestinal symptoms. It is FDA approved for adults and children over 6 years old.
• Meclizine: First-generation antihistamines are available orally over the counter.  They are approved for patients 12 years and older, but are highly sedating.
• Cinnarizine: It has higher efficacy in treating motion sickness symptoms with the least amount of drowsiness.  This drug is not available in the USA or Canada due to its calcium channel blocking properties, but is still widely used in Mexico and Europe.
• Promethazine: It is prescription-only, available in oral, rectal, and intramuscular preparations.  Promethazine has also been studied in space motion sickness, where intramuscular injections are commonly used.  Studies suggest, however, that its side effects may impair operational performance. Combination therapy with caffeine has proven effective in counteracting some side effects of promethazine.
• Sympathomimetic

Amphetamine or the highly effective combinations of amphetamine plus scopolamine (or promethazine) are not available due to legal and drug abuse reasons

Therapies Not Recommended

• Dopamine antagonists such as metoclopramide have not consistently demonstrated efficacy in the treatment of motion sickness.  Although metoclopramide is an effective antiemetic and promotes gastric emptying, studies have not demonstrated efficacy in the treatment of motion sickness [3].
• Serotonin (5-HT3) receptor antagonists like ondansetron are potent antiemetics and inhibit gastric tachyarrhythmia, but are not effective in preventing motion sickness symptoms [3].

Medications For Pregnant Patients

Pregnant women may have increased susceptibility to motion sickness. Medications used for morning sickness are felt to be safe for use in motion sickness, including meclizine and dimenhydrinate.  The FDA classifies these as category B in pregnancy.  Scopolamine and promethazine are Class C in pregnancy [3].

Treatment Recommendations for Dehydration Caused by Seasickness

If someone experiences dehydration as a result of seasickness, it’s important to act promptly to restore fluid balance and prevent complications. Here are the recommended steps:

1. Rehydration

• Oral Rehydration Solutions (ORS): Use over-the-counter ORS containing a balanced mix of water, electrolytes, and glucose (such as Pedialyte or WHO-recommended formulas). These help replenish lost fluids and essential minerals effectively
• Clear Fluids: If ORS is not available, drink clear fluids like water, broth, or diluted fruit juice. Avoid caffeinated, sugary, or alcoholic beverages, as they can worsen dehydration.
• Small Frequent Sips: If nausea persists, take small sips of fluids frequently rather than drinking large amounts at once, which may trigger vomiting.

2. Rest and Positioning

• Lie down in a cool, shaded area: Rest in a semi-reclined position to reduce nausea and aid recovery. Elevate the feet slightly to promote circulation.
• Avoid Physical Activity: Keep activity to a minimum until hydration levels return to normal.

3. Seek Medical Attention if Needed

• Intravenous Fluids (IV): If oral rehydration fails or the individual cannot keep fluids down due to ongoing vomiting, intravenous fluids may be necessary. This requires professional medical care. It is crucial to treat both the seasickness and the resulting dehydration simultaneously. Preventive measures for sea sickness should also be continued to avoid recurrence.

Are you experiencing nausea, vomiting, or dehydration due to seasickness? Don’t let seasickness ruin your island adventure! Schedule Your Seasickness Relief IV Infusion after the boat. We provide our special Infusion Drip for Seasickness. Infusion Drip therapy works quickly to provide relief from nausea, vomiting, dizziness, and discomfort.

At Nusa Medica Clinic, we specialize in fast, effective treatment for seasickness and dehydration. Our caring medical team provides:

• Professional assessment and care
• Oral and IV rehydration therapy
• Anti-nausea medications
• 24/7 emergency support.(*)

Source:

1. Brainard A, Gresham C. Prevention and Treatment of Motion Sickness. American Family Physician. 2014. https://www.aafp.org/pubs/afp/issues/2014/0701/p41.html
2. John B, Laura. Motion sickness: causes, prevention and management. The Royal Pharmaceutical Society's official journal. 2023. https://pharmaceutical-journal.com/article/ld/motion-sickness-causes-prevention-and-management
3. Takov, V., & Tadi, P. Motion Sickness. National Library of Medicine 2022. https://www.ncbi.nlm.nih.gov/books/NBK539706/
4. Golding, J. F. Health Information for International Travel. CDC Yellow Book. 2023. https://www.cdc.gov/yellow-book/hcp/travel-air-sea/motion-sickness.html

Writer: dr. Rosalia Puspita Jaya - General Practitioner Nusa Medica Clinic Gili Air