For many people, motion sickness can turn an otherwise routine trip into a distressing experience, marked by nausea, dizziness and fatigue that can linger long after the journey ends. Whether you’re on a car ride, airplane, boat or roller coaster, motion sickness is common and often unpredictable. While the symptoms are usually temporary, they can disrupt daily life, limit travel and, in some cases, signal underlying sensitivities that warrant attention.
The AMA’s What Doctors Want Patients to Know™ series gives physicians a platform to share what they want patients to understand about today’s healthcare headlines and how to take charge of their health through preventive care.
In this installment, Victor S. Wang, MD, a neurologist in Berkeley, California with Sutter Health, took time to discuss what patients should know about preventing and treating motion sickness.
Sutter Health is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Motion sickness is a physiological form of dizziness
“It’s highly variable in how it presents and who it presents in,” said Dr. Wang. “In terms of how the body processes information for balance, there are inputs that come in from visual cues, from the inner ear system, and other sensory systems like touch and proprioception are synthesized in the brain to help process the brain to say, ‘You are in a good space or you are balanced.’”
“When any one of those different systems is out of sync, you start to notice motion sickness problems,” he said. “When the body is in some type of active motion, the brain has to process all of these different systems and then any area of disconnect leads to that motion sickness sensation.”
An early sign of motion sickness is feeling off
“The first sensations are this kind of internal sensation where the body is off, so you might notice the salivation or the sweating issue,” Dr. Wang said. “You might start to notice the heart rate or blood pressure lightheadedness situation.”
“Then the nausea and the dizziness start to worsen, and you feel more fatigued as the symptoms progress. You just feel more and more wiped out,” he said.
Watch out for motion sickness symptoms
Symptoms of motion sickness often include “nausea, dizziness, vomiting, vertigo or this overall feeling unwell,” said Dr. Wang. “Other symptoms may include an increase in salivation or sweat.”
“Some people notice they may have trouble breathing, and then their extremities may go numb or tingle,” he said. “Visually, some people look more pale and then others also have this internal sense of doom that hits them. It can typically last anywhere from 36 up to 72 hours after exposure for people who are highly sensitive.”
Motion sickness is more common in women
“Motion sickness is pretty common, but more women than men get it. Young children under 2 years old don’t really seem to notice it, but typically up to 9 or so in childhood it tends to be worse and then it tends to decrease in patients as they get older,” said Dr. Wang. “Motion sickness can be quite common for people who have other medical comorbidities like migraine, anxiety, other vestibular disorders or anything like gastrointestinal-related nausea illnesses.”
“Pregnancy certainly can also increase risk,” he said, adding that motion sickness can also affect “people who have abnormal menstrual cycles or people who have some type of hormone dysregulation or regulation—such as people on oral contraceptives or women in perimenopause or menopause.”
There’s a connection between motion sickness and migraine
“Up to 50% of patients who have migraine have a prior history of motion sickness, and this is a huge impact on people who have migraine,” Dr. Wang said, noting that “a migraine is one of the most common neurologic phenomenon that affects 14% of the population—that's 40 to 50 million people in the U.S.”
“Imagine if half of those people can’t drive to work, commute or travel. So, I ask for understanding from employers and employees to have that dialogue of what it looks like to struggle getting to work,” he said. “For my patients who have migraine who also have bad motion sickness, sometimes it helps if you’re the driver but if you can’t tolerate the commute into work, mention it to your doctor and see if there’s anything your doctor’s office can do to help you work from home instead.”
“People with migraine can get worse migraine attacks associated with travel as well. So, sometimes pre-medication with certain medications can be helpful,” Dr. Wang said. “That is up to you and your doctor, but there’s tons of medicines out there that can be helpful for migraine attacks.”
Different situations can cause motion sickness
“It has to do with how people are ‘built’ for why they might notice motion sickness in one situation versus another,” Dr. Wang said. “It can be a truly anatomical reason of how your body is physically built versus a neurologic issue of how well the nerves are firing to actually transmit that information process.”
“Typically, low frequency rotations, slight movements, and rapid shifts are more commonly things that provoke the motion sickness issues,” he said. “Studies vary in terms of the prevalence, but up to about 20% of people who get onto boats will notice some type of wooziness and then up to 30% of people on bus trips might notice some type of motion sickness at one point or another.”
Motion sickness can also be felt on “roller coasters, any type of virtual reality video games, and other activities of that nature,” Dr. Wang said.
Be mindful of where and how you sit
“Where you sit or how you sit, typically lying down or positioning yourself where you have the least amount of motion relative to everything else is the best,” Dr. Wang said. “If you’re on a boat, sitting in the lower deck, or if you’re in a car being the actual driver as opposed to the passenger in the back seat, that is better because you have better visual cues when you’re up front in the car.”
It’s the same for an airplane. If “you’re on a plane sitting in the seats where the wings are, you might not notice the motion as bad,” he said. “And then, making sure you’re facing forward on the bus, train, or plane because the visual inputs are aligned with what you’re experiencing.”
Try to not focus too closely on something
“Looking out into the distance or at stationary objects can be helpful, as can looking at the horizon,” Dr. Wang said. “Not focusing is important because if you look too closely and you’re constantly moving your eyes or having to readjust the motion too frequently, it can cause motion sickness.”
Ultimately, “you should avoid reading or looking at screens when moving,” he emphasized.
Hydrate and take breaks when you can
It is also important to make “sure you are hydrated, but not too bloated before you get into the vessel itself,” Dr. Wang said. “And for car or long boat rides, it is helpful to take breaks, so making sure that you have time to get out, stretch your legs and stand still.”
Taking breaks allows “your system to catch up and not have to keep synthesizing all that info,” he said.
Cooler temperatures and a snack may help
“Anecdotally, people feel better in cooler temperatures,” Dr. Wang said. “They don't feel overheated and as though their body has to think about processing temperature as well.”
Additionally, “some people pre-boarding onto vessels will take ginger or some other type of snack to help calm their nerves a little bit,” he said.
Neuromodulation may have variable success with motion sickness
“Lately there have been more of these neuromodulation wristband devices or acupressure devices where they try to apply pressure around an extremity,” Dr. Wang said. “There’s variable evidence of effectiveness. With devices, you receive clearance from the Food and Drug Administration from a safety perspective, but an actual efficacy standpoint, it’s highly variable for what that means to an individual patient.”
“A lot of these devices cost more out of pocket, and it is a little bit more trial and error, so I would caution against putting all of your faith into these devices,” he said. “But I would also say that if you have the financial means and you don't think that traditional or conservative measures help, then it could certainly be an option to look into.”
Some medications can help with motion sickness
“I’ll offer medications if people know that they will get motion sickness and get worse afterwards or if people have medical conditions that would predispose to having motion sickness,” Dr. Wang said. “Side effects can be a huge risk-benefit of whether I offer medicines or not. I heavily counsel on knowing what to expect before taking these medicines.”
“Most of these classes of medicines can cause some form of sleepiness. Anticholinergics can cause a lot of dry mouth or blurry vision,” he said. “They can also cause confusion for older folks especially. They can also cause urinary retention. And some of the medicines are not safe with pregnancy, so always consult your ob-gyn or primary doctor whether it’s safe to take."
“The scopolamine patch is probably one of the more common meds that people will use, especially if it’s long travel. It’s a slow-release patch that people can put behind their ear to help calm things down,” Dr. Wang said. “Non-sedating antihistamines like Claritin, Zyrtec or Allegra do not seem to work as well as the sedating antihistamines, which are your Benadryl or chlorpheniramine. If you take antihistamine 30 to 60 minutes prior to getting onboard, it is helpful,” he said. “Then, the antinausea medicines—typically ondansetron (Zofran) or promethazine (Phenergan)—can be helpful for the nausea itself, but it doesn’t seem to mitigate the motion sickness.”
Even with nondrowsy, the active ingredient is sedating
“A lot of people, when they try Tylenol D or something PM, they don’t realize that that’s the Benadryl diphenhydramine that’s in it and taking that all the time can have a lot of side effects,” said Dr. Wang. “It’s helpful for the general public to know what the active ingredient is that is actually helping you.”
“Choose the brand or over the counter drugs that have the active ingredient you want, not based on what the advertisement says it does for you,” he said.
If you ever have doubts, ask your doctor
When it comes to motion sickness, “if you ever have doubts, definitely ask your local doctor about it,” Dr. Wang said. “But, most of the time, the medicines that are available to you, try the lowest possible dose and then make sure you’ve read through the package prescribing information and the usage maximums and what you can or can’t combine.
“And if you have questions, you can ask the pharmacist from wherever you’re picking up the medications from,” he added.
