Motion Sickness

Symptoms

The preliminary stages are fatigue, yawning, difficulty concentrating, headache, mood swings, lethargy, and an increased need for sleep. The actual motion sickness manifests itself acutely in symptoms such as cold sweat, pallor, pale complexion, sensations of warmth and cold, faintness, hyperventilation, rapid pulse rate, low blood pressure, salivation, nausea, nausea, vomiting, and dizziness.

Triggers

Motion sickness is triggered by a variety of motion stimuli: when traveling in a car, by train (especially tilting trains, e.g., InterCity tilting train ICN), a bus, the airplane, a ship or a spaceship, on a cable car, skiing, on a roller coaster, in a helicopter, in amusement parks, at fun fairs, on a camel (desert ship) or an elephant, a swing, in an ambulance. Simulated movements (pseudokinetosis) in the cinema, simulator, in computer / video games or the use of virtual reality goggles can also cause it. Fish can become seasick during transport of aquariums.

Causes

The causes are not fully understood and there are several attempts at explanation. According to one of the best-known theories, kinetosis is due to an internal sensory conflict triggered by two or more mismatched sensory inputs. The visual system, the vestibular system, and intrinsic sensation all report inconsistent movements. For example, if someone is reading a book on a tilting train, the visual sense reports a static environment, while the vestibular system registers rocking in the curves.

Complications

  • Motion sickness in an ambulance can worsen an existing health problem.
  • Deterioration of drug absorption due to inhibition of gastric motility.
  • Circulatory collapse

Risk factors

  • Sensitivity: anyone with a healthy vestibular organ can develop kinetosis. However, there are large differences in individual sensitivity.
  • Age: Infants do not develop kinetosis. Children between 3 and 12 years are particularly at risk. In older people kinetosis are less common.
  • Gender: Women (menstruation, pregnancy).
  • Diseases: Migraine
  • Odors
  • Alcohol consumption
  • Psychological factors, e.g. anxiety
  • Severe weather, rough seas, turbulence.

Non-drug prevention

General recommendations:

  • Sitting in the direction of travel
  • Do not consume alcohol
  • Even take over the Steurrad or rudder: Motion sickness affects almost exclusively the passengers.
  • Avoid strong odors
  • Avoid head movements
  • Controlled, regular breathing
  • With constant exposure, habituation occurs (ship: 2-4 days). It can also be achieved through specific training (astronauts, soldiers, pilots).

Car and bus:

  • Drive forward and look straight ahead in the direction of the roadway. Do not read or look out the side window. Breathe in a controlled and regular manner. Good driving technique, no fast “stop and go”.
  • When symptoms occur, do not move the head, but press against the headrest.

Ship:

  • Fix the horizon or the coast with your eyes.
  • For large ships stay in the middle of the ship, since there the movements are less. Select a cabin with a window.

Plane:

  • Seat near the wings

Drug treatment and prevention

1st generation antihistamines:

  • Dimenhydrinate is found in numerous preparations, including Trawell. The active ingredient is a combination of diphenhydramine (e.g., Benocten) and chlorotheophyllin. Chlorotheophylline is a stimulant added so that less fatigue occurs during treatment. The well-known Dramamine (out of commerce) also contained dimenhydrinate. The application must be repeated after 1-3 hours (chewing gum) or 4-6 hours (tablets).
  • Dimetindenmaleate (Feniallerg drops) is also a 1st generation antihistamine and can be administered to children (off-label!).
  • Meclozine (Itinerol B6) is commercially available in many countries in combination with caffeine and pyridoxine (vitamin B6). Caffeine is added for fatigue. Meclozin has a long duration of action of 12-24 hours.
  • Cyclizine (Marzine, out of trade).
  • Buclizine (Longifene, out of trade)

Phenothiazines:

Parasympatholytics:

  • Scopolamine is among the most effective agents for motion sickness. However, in many countries is currently no longer available preparation, the transdermal patch Scopoderm is out of trade. In other countries it is still on the market (USA: Transderm Scop). The patch is applied 4-8 hours before travel and is effective for 72 hours. Adverse effects include dry mouth, urinary retention, visual disturbances, and fatigue. Transdermal application is not essential; scopolamine can also be applied orally, nasally or sublingually, among others.

Calcium channel blockers:

Phytopharmaceuticals:

  • Ginger (eg Zintona, ginger as a medicinal drug (daily dose 4 g) or ginger tentli, ginger tea, candied ginger). Zintona is taken half an hour before the start of the trip and then every 4 hours (500 mg each ginger powder).

Other treatment options

Placebo:

  • Shows good efficacy in clinical trials

The following agents are effective but not well tolerated, not approved for this indication, and may be addictive:

Alternative medicine: homeopathics and anthroposophics such as Cocculine, Cocculus-Homaccord, Nausetum, Similasan travel ailments, Wala Aurum Valeriana Globuli velati, Weleda Nausyn (aH):

  • Anamirta cocculus
  • Cephaelis ipecacuanha
  • Cerium oxalicum
  • Hyoscyamus niger
  • Mandragora
  • Nicotiana tabacum
  • Petroleum
  • Strychnos nux vomica
  • Theridion curassavicum

Acupuncture and acupressure:

  • Sea Band bracelet for adults or children

The following agents are ineffective according to the literature:

Consultation notes on drug treatment.

  • When taking preventive medication, it should be noted that, depending on the preparation, the medication must be applied for half an hour to an hour, several hours or already the day before.
  • Travel gums (dimenhydrinate, Trawell) are chewed at the first signs during 3-10 minutes. They can also be chewed preventively.
  • The duration of action of each active substance must be observed. Depending on the duration of the trip, a repeated intake after a few hours is necessary. Meclozine has a long duration of action of 12-24 hours.
  • Antihistamines and parasympatholytics make you tired. In addition, the contraindications, interactions and other possible adverse effects must be considered.
  • The consumption of alcohol should be avoided because it increases the adverse effects of the drugs and aggravates kinetosis.