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Motion sickness

Background

Overview

Definition
Motion sickness is a common condition that results from an adverse physiologic response to real or perceived motion stimuli, typically involving low-frequency vertical, lateral, angular, or rotary motion, occurring during travel by sea, land, air, or immersion in virtual reality.
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Pathophysiology
The pathophysiology of motion sickness involves a conflict between expected and actual interactions among vestibular, visual, and proprioceptive inputs. When vestibular signals about motion and changes in position are inconsistent with visual or proprioceptive inputs, a mismatch can occur, triggering the autonomic nervous system and activating the vomiting center in the brainstem.
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Epidemiology
The prevalence of motion sickness in school-age children and young adults is estimated at 35-43% and 25%, respectively. Seasickness is the most frequent and notable form of motion sickness.
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Disease course
The clinical course of motion sickness typically begins with a feeling of unease, followed by cold sweats and dizziness, progressing to nausea and, in severe cases, vomiting. Symptoms can be exacerbated by factors such as anxiety, fatigue, and poor ventilation. Once the motion stops, symptoms usually resolve quickly, although some individuals may feel unwell for a few hours or even days.
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Prognosis and risk of recurrence
The prognosis for motion sickness is generally good. Treatment options include pharmacologic interventions, such as antihistamines and scopolamine, behavioral modifications, such as focusing on the horizon and avoiding reading during travel, and desensitization techniques, such as gradually increasing exposure to the triggering motion.
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Guidelines

Key sources

The following summarized guidelines for the management of motion sickness are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2024,2014). ...
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Medical management

Pharmacotherapy, prevention
As per AAFP 2014 guidelines:
Offer scopolamine as the first-line medication for preventing motion sickness in patients wishing to maintain wakefulness during travel.
A
Offer first-generation antihistamines for preventing motion sickness, recognizing that these agents often have sedative and other side effects.
B
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  • Pharmacotherapy (management)

Nonpharmacologic interventions

Body positioning and visual attention
As per AAFP 2014 guidelines:
Advise patients to focus on a fixed point on the horizon and avoid close visual tasks while in vehicles to prevent and reduce symptoms of motion sickness.
B
Advise patients to actively steer, tilt their head into turns, recline, stabilize their head and body, or rest with their eyes closed while in vehicles to prevent and reduce symptoms of motion sickness.
B