Chapter 8 Travel by Air, Land & Sea

Motion Sickness

Stefanie K. Erskine

RISK FOR TRAVELERS

Motion sickness is the term attributed to physiologic responses to travel by sea, car, train, air, and virtual reality immersion. Given sufficient stimulus, all people with functional vestibular systems can develop motion sickness. However, people vary in their susceptibility. Risk factors include the following:

  • Age—children aged 2–12 years are especially susceptible, but infants and toddlers are generally immune. Adults >50 years are less susceptible to motion sickness.
  • Sex—women are more likely to have motion sickness, especially when pregnant, menstruating, or on hormones.
  • Migraines—people who get migraine headaches are more prone to motion sickness, especially during a migraine.
  • Medication—some prescriptions can worsen the nausea of motion sickness.

CLINICAL PRESENTATION

Travelers suffering from motion sickness commonly exhibit some or all of the following symptoms:

  • Nausea
  • Vomiting/retching
  • Sweating
  • Cold sweats
  • Excessive salivation
  • Apathy
  • Hyperventilation
  • Increased sensitivity to odors
  • Loss of appetite
  • Headache
  • Drowsiness
  • Warm sensation
  • General discomfort

PREVENTION

Nonpharmacologic interventions to prevent or treat motion sickness include the following:

  • Being aware of and avoiding situations that tend to trigger symptoms.
  • Optimizing position to reduce motion or motion perception—for example, driving a vehicle instead of riding in it, sitting in the front seat of a car or bus, sitting over the wing of an aircraft, holding the head firmly against the back of the seat, and choosing a window seat on flights and trains.
  • Reducing sensory input—lying prone, shutting eyes, sleeping, or looking at the horizon.
  • Maintaining hydration by drinking water, eating small meals frequently, and limiting alcoholic and caffeinated beverages.
  • Avoiding smoking—even short-term cessation reduces susceptibility to motion sickness.
  • Adding distractions—controlling breathing, listening to music, or using aromatherapy scents such as mint or lavender. Flavored lozenges may also help.
  • Using acupressure or magnets is advocated by some to prevent or treat nausea, although scientific data on efficacy of these interventions for preventing motion sickness are lacking.
  • Gradually exposing oneself to continuous or repeated motion sickness triggers. Most people, in time, notice a reduction in motion sickness symptoms.

TREATMENT

Antihistamines are the most frequently used and widely available medications for motion sickness; nonsedating ones appear to be less effective. Antihistamines commonly used for motion sickness include cyclizine, dimenhydrinate, meclizine, and promethazine (oral and suppository). Other common medications used to treat motion sickness are anticholinergics such as scopolamine (hyoscine—oral, intranasal, and transdermal), antidopaminergic drugs (such as prochlorperazine), metoclopramide, sympathomimetics, and benzodiazepines. Clinical trials have not shown that ondansetron, a drug commonly used as an antiemetic in cancer patients, is effective in the prevention of nausea associated with motion sickness.

Medications in Children

Although using antihistamines to treat motion sickness in children is considered off-label, for children aged 2–12 years, dimenhydrinate (Dramamine), 1–1.5 mg/kg per dose, or diphenhydramine (Benadryl), 0.5–1 mg/kg per dose up to 25 mg, can be given 1 hour before travel and every 6 hours during the trip. Because some children have paradoxical agitation with these medicines, a test dose should be given at home before departure. Oversedation of young children with antihistamines can be life-threatening.

Scopolamine can cause dangerous adverse effects in children and should not be used; prochlorperazine and metoclopramide should be used with caution in children.

BIBLIOGRAPHY

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