Motion sickness

Motion sickness, or travel sickness, is a common problem that affects many of us. You can feel motion sick on any type of transport - cars, trains, buses, trams, boats or planes - as well as on playground or fairground rides. You can even get motion sick while watching images on a screen that make you feel as if you are moving (including movies, television, virtual reality displays or computer animations).

Anyone can get motion sickness, but some people are affected more than others. Infants and toddlers tend to be resistant to motion sickness, while children aged around 2–12 years are most susceptible. Thankfully, many people grow out of motion sickness, but for those who don’t, there are treatments and things you can do to help prevent motion sickness or ease the symptoms, making travel a much more pleasant experience for those who get travel sick and their travel companions.

Symptoms of motion sickness

The severity of motion sickness and how quickly it develops depends on the intensity of the movement. Even people who are rarely troubled by motion sickness can feel unwell if the movement is intense enough.

Symptoms can include:

  • a feeling of uneasiness or stomach discomfort;
  • sweating/ cold sweats;
  • dry mouth;
  • burping;
  • nausea;
  • vomiting (infrequent in adults);
  • dizziness or feeling light-headed;
  • headaches; and
  • yawning and sleepiness.

Some people find that they only have symptoms on certain forms of transport - for example, they feel fine when they travel by train or car, but tend to get seasick when they travel by ship or boat.

Symptoms such as nausea and headache can sometimes continue for several hours after the movement (or perceived movement in the case of simulated visual motion) has stopped. Many people notice an ongoing sense of motion after getting off a boat, which usually lasts from a few hours to a few days.

Causes and risk factors

Motion, or movement, triggers travel sickness in susceptible people. It happens because the movement sensed by your inner ear is different from what you are seeing, and the conflicting messages sent to your brain about what you are feeling and seeing makes you feel unwell.

Children aged 2-12 years (especially those 10-12 years) and pregnant women seem to be most affected by travel sickness. It is also more common in people who get migraines and people who have family members who are affected by motion sickness. Women may be more prone to motion sickness around the time of menstruation.

If you are prone to motion sickness, you may be more likely to develop symptoms (or have more severe symptoms) if:

  • you travel on an empty stomach;
  • you sit at the back of a bus or tram;
  • you sit facing backwards;
  • you read a book or map while travelling;
  • you use an electronic device while travelling; or
  • conditions are stuffy and there is no access to fresh air or air conditioning.

You may become less susceptible to motion sickness during an extended trip, such as a cruise, because your body tends to get used to the motion after a few days.

Will I grow out of motion sickness?

Fortunately, many children stop getting motion sick as they get older. Travel sickness appears to peak around puberty, but then usually improves during adolescence and adulthood for many people.

When to see your doctor

Most people are able to work out for themselves if they suffer from motion sickness. However, it’s a good idea to see your doctor if you have frequent or severe symptoms when travelling. Your doctor can rule out other conditions that could be causing your symptoms or making them worse, and suggest tips and treatments that can help your travel sickness.

While there are no special tests to help diagnose motion sickness, your doctor may ask whether you feel sick if you read while travelling by car, because this is a good indicator of how susceptible you are to travel sickness.

How to prevent and treat travel sickness

There are several self-care measures and medicines that can help prevent and treat motion sickness. While you may need to try a few different techniques to work out what works best for you, many people can prevent (or at least reduce) motion sickness with a little planning before a trip. Also, many people find that they become less sensitive to travel sickness the more they travel.

Self-care for motion sickness

It’s a good idea to try some simple, self-care measures before turning to medicines for mild motion sickness.

Before you travel

Eat a light snack because travelling on an empty stomach tends to make travel sickness worse. Plain crackers are often a good choice while you are travelling. Avoid large, greasy or spicy meals and alcohol before and while travelling.

Choose carefully where you sit - try the following tips.

  • If possible, be the driver or sit in the front seat when travelling by car. It’s best if the car travels smoothly - jerky stop-start movements are not helpful.
  • Sit as close to the front as possible when travelling by bus, train or tram, and choose a window seat facing forwards.
  • When flying, sit over the front edge of the aeroplane wing – the ride tends to be less bumpy.
  • Choose a cabin at the front or middle of a ship, near the waterline, where there tends to be less movement.

While you are travelling

Practice controlled breathing. Breathing at a regular rate, and a steady, moderate depth (not too deeply) can help prevent and relieve symptoms.

Try not to move your head around too much – it may help to use pillows or a headrest. When travelling by plane, keep your head and body as still as possible during turbulence by strapping your seatbelt on tightly and gripping the seat with your arms and legs. Sit still during take-off and landing.

Watch where you look. Try looking out the window and focussing on the horizon, the road ahead or a distant stationary object. If you can’t see outside, close your eyes. In fact, closed eyes is the best tactic for some people regardless - trial and error will tell you what works best for you. If travelling by plane, close your eyes or avoid looking out the window during take-off and landing. If travelling on a high-speed, tilting train it may be best to focus your attention inside.

Try to avoid strong or unpleasant smells (such as diesel fumes from the engine of a boat), if possible.

Keep cool – open the window or use air conditioning.

Try reclining in your seat or lying down if it is possible and safe to do so.

It may help to try to distract children by talking, singing or listening to music or an audio book.

Avoid reading or using a device (including a phone or tablet) while travelling.

When travelling by sea, try spending time on deck. On a large boat, it can help some people to spend time out on deck in the fresh air, looking at the horizon. But for others, lying down in your cabin with your eyes closed gives better relief.

Avoid going on rides at amusement parks that are likely to cause symptoms - experience will tell you which types of movement are likely to cause problems.

Medicines

There are medicines available in Australia to help with motion sickness, including tablets, chewable tablets and liquid medicine (elixir). Skin patches for travel sickness are not currently available in Australia, but can be purchased overseas.

Available medicines for motion sickness include the following.

  • Antihistamines, including promethazine (examples of brand names include Avomine, Allersoothe and Phenergan) and pheniramine (brand name Avil). Another type of antihistamine called cyclizine (brand name Nausicalm) may be used in adults only. These sedating antihistamines seem to be more effective than the newer, non-sedating antihistamines.
  • Hyoscine hydrobromide (e.g. Kwells, Travacalm HO).
  • A combination medicine containing dimenhydrinate (an antihistamine), hyoscine hydrobromide and caffeine (brand name Travacalm Original).

In general, medicines should be used only occasionally when travelling. They should be taken several hours before travelling, because they are more effective at preventing symptoms than treating symptoms after they have developed.

Most travel sickness medicines are available from pharmacies without a prescription, but you should always check with your doctor or pharmacist whether medicines are suitable for you or your child before taking them. Not all medicines are suitable for children of all ages. Also, be sure to check the dose according to the age of the child.

Medicines used to treat motion sickness may cause drowsiness. You should not drive or operate machinery if you’ve taken these medicines. Children (and some adults) sometimes become agitated after taking some antihistamine medicines, so it’s best to trial the medicine for the first time while you are still at home.

Many medicines used for travel sickness should not be taken with alcohol.

Treatment for severe motion sickness

Rough conditions at sea can test anyone, even those travelling on large boats such as cruise ships. An injection of promethazine (a type of sedating antihistamine) can be given for severe sea sickness (or any severe motion sickness). Hyoscine can also be given by injection for severe motion sickness. These medicines cause sedation, so should only be taken if you don’t need to carry out tasks that require your full attention.

People who have severe motion sickness and are on an extended journey (for example if you are on a cruise and will be travelling for days or weeks) need to be careful not to become dehydrated. You can easily become dehydrated if you have uncontrollable vomiting and are not able to keep down any fluids. See the doctor on board for treatment - you may need to be given fluids via a drip in your arm.

Other treatments

For people who can’t avoid regular travel and don’t respond to self-help measures, a treatment called habituation may be recommended. This involves repeated exposures to motion, gradually increasing in duration, to help you become desensitised to its effects. If symptoms are severe, a type of psychotherapy called cognitive behavioural therapy (CBT) may be recommended at the same time as habituation to help you manage any associated anxiety and negative thinking patterns. These treatments are most often used for people involved in defence force occupations such as the navy or airforce.

If you have migraines, getting treatment for your migraines may help your motion sickness.

Natural remedies

Natural remedies for motion sickness include the following.

  • Acupressure. Stimulation of a certain acupressure point known as the P6 acupressure point - found on the inside of the wrist about 3 finger-breadths from the base of your hand - may help with travel sickness. You can apply pressure by pressing on the P6 acupressure point with your fingers or by using an acupressure band or bracelet (e.g. Sea-Band), available from pharmacies.
  • Ginger may help relieve symptoms. Try eating ginger biscuits or lollies, or drinking ginger tea or ginger ale. Ginger is also available in tablet form (e.g. Travacalm Natural).
  • Aromatherapy using mint or lavender may help.

Most children and adults are able to control or reduce motion sickness with these tips and treatments. And the good news is that many people grow out of motion sickness as they get older.

References

1. Motion sickness (published November 2017). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2018 Mar. https://tgldcdp.tg.org.au (accessed Mar 2018).
2. MayoClinic.com. Motion sickness: first aid (updated 15 Oct 2011). http://www.mayoclinic.com/health/first-aid-motion-sickness/HQ01099 (accessed Feb 2013).
3. Centers for Disease Control and Prevention (CDC). Travellers’ Health: Motion sickness (updated 31 May 2017). https://wwwnc.cdc.gov/travel/yellowbook/2018/the-pre-travel-consultation/motion-sickness (accessed Mar 2018).
4. NHS Choices. Motion sickness (updated 31 Aug 2017). https://www.nhs.uk/conditions/motion-sickness/ (accessed Mar 2018).
5. BMJ Best Practice. Motion sickness (reviewed Feb 2018). http://bestpractice.bmj.com/ (accessed Mar 2018).
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