Motion sickness

What is motion sickness?

Symptoms of nausea, dizziness or vomiting, caused by travel in a vehicle, boat or aeroplane, is known as motion sickness. It can also be caused by playing video games or walking or standing on moving platforms, for example a pontoon on a lake.

What causes motion sickness?

Motion sickness is a response to repeated movements, such as going over bumps or around in a circle, which send lots of messages to the brain.

If sitting inside a vehicle or on a boat, particularly when focusing on things that are also inside the vehicle (such as a book or screen), then the eyes are sending signals to the brain that the person's position is not changing, whilst the balance mechanisms are sending signals to the brain that the person's position is constantly changing.

On a fairground ride when being spun in different directions, the eyes, the muscles and the balance sensors are all sending different messages to the brain at once.

These conflicting messages cause people to experience motion sickness.

Is motion sickness normal?

Motion sickness is very common and is a normal response that anyone can have when experiencing real or perceived motion. Everyone can develop motion sickness if exposed to sufficiently intense motion but some people are very rarely affected while other people are more susceptible and have to deal with motion sickness very often.

Triggers for motion sickness

Motion sickness is more common in children and in women. Most children grow out of having motion sickness. It is not known why some people develop motion sickness more than others.

Symptoms can develop in cars, trains, planes and boats and on amusement park rides, etc. Sometimes trying to read a book or a map whilst travelling can trigger motion sickness. Strong smells whilst travelling can also trigger motion sickness.

Playing computer games can sometimes cause motion sickness to occur.

Motion sickness symptoms

There are various symptoms of motion sickness including:

• Feeling sick (nausea and vomiting).

• Sweating and cold sweats.

• Increase in saliva.

• Headaches.

• Feeling cold and going pale.

• Feeling weak.

How long does motion sickness last?

Symptoms typically go when the journey is over; however, in some people they can last for a few hours, or even days, after the journey ends.

How to stop motion sickness

Some general tips to avoid motion sickness include the following:

Prepare for the journey

• Don't eat a heavy meal before travelling. Light, carbohydrate-based food like cereal, pasta or toast an hour or two before travelling is best.

• On long journeys, try breaking the journey to have some fresh air, drink some cold water and, if possible, take a short walk.

For more in-depth advice on travelling generally, see the separate leaflets called Health advice for travel abroad, Travelling to remote locations, Ears and flying (Aeroplane ear), Jet lag and Altitude sickness.

Plan where to sit

• Keep motion to a minimum. For example, try to sit in the front seat of a car, over the wing of a plane, or on deck in the middle of a boat.

• On a boat, stay on deck and avoid sitting where the engines can be smelt.

Breathe fresh air

• Breathe fresh air if possible. For example, open a car window.

• Avoid strong smells, particularly petrol and diesel fumes. This may mean closing the window and turning on the air conditioning, or avoiding the engine area in a boat.

Use eyes and ears differently

• Close your eyes (and keep them closed for the whole journey). This reduces 'positional' signals from your eyes to your brain and reduces the confusion.

• Don't try to read.

• Try listening to an audio book with your eyes closed. There is some evidence that distracting your brain with audio signals can reduce your sensitivity to the motion signals.

• Try to sleep - this works mainly because your eyes are closed, but it is possible that your brain is able to ignore some motion signals when you are asleep.

• Do not read or watch a film.

• It is advisable not to watch moving objects such as waves or other cars. Don't look at things your brain expects to stay still, like a book inside the car. Instead, look ahead, a little above the horizon, at a fixed place.

• If you are the driver you are less likely to feel motion sickness. This is probably because you are constantly focused on the road ahead and attuned to the movements that you expect the vehicle to make. If you are not the driver, then sitting in the front and watching what the driver is watching can be helpful.

Treat your tummy gently

• Avoid heavy meals and do not drink alcohol before and during travelling. It may also be worth avoiding spicy or fatty food.

• Try to 'tame your tummy' with sips of a cold water or a sweet, fizzy drink. Cola or ginger ale are recommended.

Try alternative treatments

• Sea-Bands® are acupressure bands that can be worn on the wrists to put pressure on acupressure points that Chinese medicine suggests affects motion sickness. Some people find that they are effective.

• Homeopathic medicines seem to help some people, and will not cause drowsiness.

Natural treatments for motion sickness

All the techniques above which aim to prevent motion sickness will also help reduce it once it has begun. Other techniques, which are useful on their own to treat motion sickness but can also be used with medicines if required, are:

• Breathe deeply and slowly and, while focusing on breathing, listening to music. This has been proved to be effective in clinical trials.

• Ginger can improve motion sickness in some people (as a biscuit or sweet, or in a drink).

Motion sickness medicines

There are several motion sickness medicines available which can reduce, or prevent, symptoms of motion sickness. They can be bought from pharmacies. They work by interfering with the nerve signals described above.

Medicines are best taken before the journey. They may still help even if taken after symptoms have begun, although medicines are absorbed less well once nausea has started. Therefore, skin patches or medications absorbed through the gums are more effective after nausea has already developed.

Hyoscine

Hyoscine is usually the most effective medicine for motion sickness. It is also known as scopolamine. It works by preventing the confusing nerve messages going to the brain.

There are several brands of medicines which contain hyoscine - they also come in a soluble form for children. A dose should be taken 30-60 minutes before a journey; the effect can last up to 72 hours.

Hyoscine also comes as a patch for people aged 10 years or over. (This is only available on prescription - see below.) Side-effects of hyoscine include dry mouth, drowsiness and blurred vision.

Antihistamines

Antihistamines can also be useful, although they are not quite as effective as hyoscine. However, they usually cause fewer side-effects.

Several types of antihistamine are sold for motion sickness. All can cause drowsiness, although some are more prone to cause it than others; for example, promethazine, which may be of use for young children on long journeys, particularly tends to cause drowsiness. Older children or adults may prefer one that is less likely to cause drowsiness - for example, cinnarizine or cyclizine.

Remember, children who have taken medicines which cause drowsiness can sometimes be irritable when the medicines wear off.

See the separate article called How to manage motion sickness.

Side-effects of motion sickness medicines

Some medicines used for motion sickness may cause drowsiness. Some people are extremely sensitive to this and may find that they are so drowsy that they can't function properly at all.

For others the effects may be milder but can still impair reactions and alertness. It is therefore advisable not to drive and not to operate heavy machinery after taking these. In addition, some medicines may interfere with alcohol or other medication; the pharmacist can advise you about this.

What can a doctor prescribe for motion sickness?

There are a number of anti-sickness medicines which can only be prescribed. Not all of them always work well for motion sickness, and finding something that works may be a case of trial and error. They are not usually better than the over-the-counter options. In some areas of the UK, they are not recommended for prescribing.

All of them work best taken up to an hour before the journey, and work less well if used when already feeling sick. See also the separate leaflet called Nausea medicine for more detailed information about these medicines.

Hyoscine patch

Hyoscine, or scopolamine, patches are suitable for adults and for children over 10 years old. The medicine is absorbed through the skin, although this method of medicine delivery is slow so the patch works best if applied well before your journey. The patch needs to be stuck onto the skin behind the ear 5-6 hours before travelling (often this will mean late on the previous night) and removed at the end of the journey. There is no evidence that this works better than any other medications for motion sickness.

Prochlorperazine

Prochlorperazine is a prescription-only medicine which works by changing the actions of the chemicals that control the tendency to be sick (vomit) in the brain.

One form of prochlorperazine is Buccastem®, which is absorbed through your gums and does not need to be swallowed. Buccastem® tastes rather bitter but it can be effective for sickness when already feeling sick as it doesn't have to be absorbed by the stomach.

Metoclopramide

Metoclopramide is a tablet used to speed up the emptying of your tummy. Slow emptying of the tummy is something that happens when you develop nausea and vomiting, so metoclopramide can help prevent this.

It prevents nausea and vomiting quite effectively in some people. It can have unpleasant side-effects, particularly in children (in whom it is not recommended).

Metoclopramide is often helpful for those who tend to have gastric reflux, those who have slow tummy emptying because of previous surgery, and those who have type 1 diabetes.

Ondansetron

Ondansetron is a powerful antisickness medicine which is most commonly used for sickness caused by chemotherapy, and occasionally used for morning sickness in pregnancy. It is not usually effective for motion sickness. This, and its relatively high cost, means that it is not prescribed for motion sickness alone. However, for those undergoing chemotherapy, and for those who have morning sickness aggravated by travel, ondansetron may be helpful.

What should I do if I'm actually sick?

Vomiting may relieve the symptoms of motion sickness a little, although not always for very long. After being sick:

• Try a cool flannel on your forehead, try to get some fresh air on your face and do your best to find a way to rinse your mouth to get rid of the taste.

• Don't drink anything for ten to twenty minutes (or it may come straight back), although (very) tiny sips of very cold water, coke or ginger ale may help.

• After this, go back to taking all the prevention measures above.

• Once you reach your destination you may continue to feel unwell. Sleep if you can, sip cold iced water, and - when you feel ready - try some small carbohydrate snacks. Avoid watching TV (more moving objects to watch!) until you feel a little better.

What is disembarkation syndrome?

The sensation, also called 'mal de debarquement' (French for sickness on disembarking), refers to the sensation that some people experience after travel on a boat, train or plane, when they continue to feel for some time as though the ground is rocking beneath their feet.

It is probably caused by the overstimulation of the balance organs during the journey. It usually lasts only an hour or two, but in some people it can last for several days, particularly after a long sea journey. It does not usually require any treatment.

Persistent mal de debarquement syndrome is an uncommon condition in which these symptoms may persist for months or years.

Dr Mary Lowth is an author or the original author of this leaflet.