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Overview |
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Definition |
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Motion sickness is discomfort that occurs during travel in a moving vehicle
such as a car, boat, or airplane. It represents a normal response to sensory
conflict and changes in motion patterns. |
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Etiology |
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Motion sickness occurs when vestibular system input conflicts with visual
cues, e.g., when the body senses rolling motions which are not visually apparent
from inside a ship's cabin, or conversely during a "virtual reality" simulation
when the eyes perceive movement that is not experienced by the body. Asymmetry
can occur between right and left otolith mass. |
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Risk Factors |
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- Exposure to motion stimuli
- Youth and/or inexperience with the form of motion
- Predisposition to nausea or vomiting
- Fear or anxiety
- Exposure to unpleasant odors
- Poor ventilation
- Zero gravity
- Asian descent
- Female gender
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Signs and Symptoms |
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- Dizziness
- Pallor
- Cold sweating
- Hypersalivation
- Nausea
- Vomiting
- Fatigue
- Headache
- Malaise
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Differential
Diagnosis |
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- Migraine
- Vestibular disease
- Metabolic disorders
- Vertigo
- Viral illness
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Diagnosis |
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Patient rarely arrives at a physician's office actually suffering from motion
sickness; more often a health care provider will be asked for advice and
preventives after an episode or in anticipation of future
travel. |
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Physical Examination |
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Patient may appear pale and/or weak, complain of nausea, and possibly have an
elevated heart rate. |
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Laboratory Tests |
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Laboratory tests are not necessary to establish a diagnosis of motion
sickness. However, in clinical studies, elevated salivary cortisol is sometimes
used as an index. |
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Other Diagnostic
Procedures |
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Question patient about the precipitating event and course and duration of
symptoms to establish a diagnosis of motion
sickness. |
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Treatment Options |
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Treatment Strategy |
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Motion sickness is not in itself dangerous, but may become dangerous if it
occurs during the operation of machinery or during driving. Removing or
minimizing exposure to the stimuli will help to alleviate the symptoms. Avoid
fixation on moving objects. |
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Drug Therapies |
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For the short term, suggest OTC antihistamines:
- Cyclizene (Marezine): 50 mg 30 to 60 minutes before travel and every
four to six hours as necessary. For children ages 6 to 11, 25 mg every six to
eight hours. Not recommended for children younger than 6.
- Dimenhydrinate (Dramamine): 50 to 100 mg every four to six hours. For
children ages 6 to 11, 25 to 50 mg every six to eight hours. For children ages 2
to 5, 12.5 to 25 mg every six to eight hours.
- Meclizine (Bonine, Antivert, Dramamine II): 25 to 50 mg once daily.
Not recommended for patients younger than 12.
Antihistamines are effective for both prevention and treatment. These
products are contraindicated in patients with breathing problems, glaucoma, or
an enlarged prostate causing difficulties in urination. Antihistamines often
cause drowsiness and should not be used while driving. The drowsiness effect is
most pronounced with dimenhydrinate.
For the longer term, scopolamine patch placed behind the ear six to eight
hours before travel will last up to three days. Side effects may include dry
mouth, drowsiness, blurred vision, and disorientation. Scopolamine is not
effective if administered after the onset of symptoms and may interact with
alcohol, antihistamines, and antidepressants.
Phenytoin, amphetamine, and other norepinephrine-releasing agents (e.g., 25
mg promethazine in combination with 25 mg ephedrine one hour before travel) can
be effective if not contraindicated. |
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Complementary and Alternative
Therapies |
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Digestive herbs and/or homeopathic remedies may be helpful in preventing and
relieving motion sickness. As with most therapies, alternative therapies for
motion sickness are best used before the onset of symptoms.
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Nutrition |
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Avoid alcohol and caffeine. If there is concurrent respiratory involvement,
eliminate pro-inflammatory and mucus promoting foods such as dairy products,
fruit, and sugar. Ginger root (Zingiber officinale) sliced and chewed may
prevent the onset of motion sickness. Encapsulated ginger, crystallized ginger,
or ginger snaps may also be effective. Ginger may be as effective as Dramamine
if taken one hour before needed. Sips of lemon water may help relieve nausea
from motion sickness. |
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Herbs |
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Herbs are generally a safe way to strengthen and tone the body's systems. As
with any therapy, it is important to ascertain a diagnosis before pursuing
treatment. Herbs may be used as dried extracts (capsules, powders, teas),
glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless
otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water.
Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for
roots. Drink 2 to 4 cups/day. Tinctures may be used singly or in combination as
noted.
Ginger root in a tea (frequent small sips) or tincture (30 drops in ½ cup of
water as needed). May add peppermint (Mentha piperita) and/or
chamomile (Matricaria recutita) if there is vomiting.
Black horehound (Ballota nigra) may help relieve nausea secondary to
inner ear problems. May be used as tea (1 cup tid) or tincture (30 drops
tid). |
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Homeopathy |
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An experienced homeopath should assess individual constitutional types and
severity of disease to select the correct remedy and potency. For acute
prescribing use 3 to 5 pellets of a 12X to 30C remedy every one to four hours
until acute symptoms resolve.
- Cocculus for motion sickness and vertigo from watching moving
objects.
- Petroleum for motion sickness with cold sensation in the
abdomen.
- Tabacum for unrelenting nausea with cold
sweat.
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Acupuncture |
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P6 acupressure may reduce symptoms of sea sickness. Use "Sea Bands" as
commercially available, as these may be very effective. |
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Massage |
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Massage or other relaxation techniques may help control motion
sickness. |
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Patient Monitoring |
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Patients should be instructed to report any unusual side effects resulting
from medication for motion sickness. |
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Other
Considerations |
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Prevention |
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Patients should avoid reading while in a moving vehicle, preferably keeping
their eyes on the scene outside. Driving or piloting the vehicle provides
protection from motion sickness, since it necessarily involves constant
observation of the outside environment. For children, an elevated car seat
allowing a view out the window is helpful. Patients should get as much fresh air
as possible, avoid twisting the neck, and avoid eating or drinking heavily
before travel. If possible, select a seat or cabin where the vehicle's motion is
least perceptible, such as near the waterline of a boat or in the center of a
plane. Diaphragmatic breathing may help prevent motion
sickness. |
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Complications/Sequelae |
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Motion sickness has no long-term complications. |
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Prognosis |
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The symptoms generally disappear quickly after travel is concluded. Patients
often acclimate during a trip of several days or after repeated exposures to the
same type of experience. |
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Pregnancy |
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Ginger should be used with caution in the first trimester of
pregnancy. |
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References |
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Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic
Guide to Herbal Medicines. Boston, Mass: Integrative Medicine
Communications; 1998:429.
Dobie TG, May JG. The effectiveness of a motion sickness counselling
programme. Br J Clin Psychol. 1995;34 (part 2):301-311.
Gresty MA, Grunwald EA. Medical perspective of motion sickness. In:
Proceedings of the International Workshop on Motion Sickness: Medical and Human
Factors; May 1997; Marbella, Spain.
Helling K, Hausmann S, Flottmann T, Scherer H. Individual differences in
susceptibility to motion sickness [in German]. HNO. 1997;45:210-215.
Hoffman D. The New Holistic Herbal. New York, NY: Barnes & Noble
Books; 1995:181.
Hu S, Stritzel R, Chandler A, Stern RM. P6 acupressure reduces symptoms of
vection-induced motion sickness. Aviat Space Environ Med.
1995;66:631-634.
Jozsvai EE, Pigeau RA. The effect of autogenic training and biofeedback on
motion sickness tolerance. Aviat Space Environ Med. 1996;67:963-968.
Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms.
Albany, Calif: Hahnemann Clinic Publishing; 1993:133, 288, 379.
Pray WS. Motion sickness: a sensory conflict. U.S. Pharmacist. March
1998.
Ramsey A. Virtual reality induced symptoms and effects: a psychophysiological
prespective. In: Proceedings of the International Workshop on Motion Sickness:
Medical and Human Factors; May 1997; Marbella, Spain.
Stern RM, Hu S, Uijtdehaage SH, Muth ER, Xu LH, Koch KL. Asian
hypersusceptibility to motion sickness. Hum Hered.
1996;46:7-14. |
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Copyright © 2000 Integrative Medicine
Communications This publication contains
information relating to general principles
of medical care that should not in any event be construed as specific
instructions for individual patients. The publisher does not accept any
responsibility for the accuracy of the information or the consequences arising
from the application, use, or misuse of any of the information contained herein,
including any injury and/or damage to any person or property as a matter of
product liability, negligence, or otherwise. No warranty, expressed or implied,
is made in regard to the contents of this material. No claims or endorsements
are made for any drugs or compounds currently marketed or in investigative use.
The reader is advised to check product information (including package inserts)
for changes and new information regarding dosage, precautions, warnings,
interactions, and contraindications before administering any drug, herb, or
supplement discussed herein. |