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MOTION SICKNESS As a pilot and physician, people frequently ask me about motion sickness, especially if they are going flying with me. I am always very cautious when flying with new passengers, as it is just as unpleasant for me when someone gets sick in my airplane. It is interesting that I, too, will get car sick as a passenger or when flying in very turbulent air. I have completed some aerobatics training and will usually last about an hour, before I need to quit. Thus, it does take some conditioning in order to prevent motion sickness. Let’s take a look at this common concern for travelers with impending trips. What is motion sickness? This is a syndrome that will occur when one has a perceived sense of motion or a real response to motion. It can occur in a variety of venues including cars, trains, airplanes, carnival rides, or even in theaters when watching an action packed film. A person may experience a sense of dizziness or vertigo. Vertigo is a sense of spinning, even though the body remains fixed and still. This central nervous symptom response may include nausea, vomiting, headache and fatigue. A person’s balance system is affected and the brain inputs become confused. A variety of signals within the brain are affected. From an anatomic perspective, the causes are not well understood. This condition was first described by Hippocrates and was noted in response to boat travel by the Greeks. The Greek term for ship is naus, and thus the term nausea. Who is affected? Medical literature has shown that more women than men are affected; the reason for this discrepancy is not clear. Motion sickness also seems to decrease with age. It has been shown that children under two years are completely unaffected. The incidence of motion sickness peaks by the age of 12 and will then decrease for most people. It is also well known that there are hormonal factors involved with motion sickness and pregnant women are at significant risk. Patients with a history of migraines are at greater risk as well. There may be a psychological component to motion sickness – when Naval recruits are repeatedly told that they will not experience seasickness, they did not experience any symptoms. What can be done? Environmental control and stimulation is important. Motion sickness does not usually occur with self-generated movements, such as driving a car versus being a passenger. Watching the horizon when on a ship and looking out from the deck is also better that looking out a small cabin window. Medications are effective and a low dose antihistamine, meclizine, is the mainstay for treatment. This drug comes in prescribed form and as an over-the-counter lower dose called Bonine. Both medications are the same, but the over-the-counter version will require that more pills be taken at one time. We use this in the Emergency Department when treating an inner ear problem causing vertigo. Some antinauseant medications, such as phergan, may be effective. Studies have shown that there are other medications that are marginally effective, compared to meclizine. It is has also been shown that sedatives like Valium do not work well. Scopolamine is another effective medication and studies have shown that it is best at preventing motion sickness. It can be used as a patch and will last for 72 hours. Unfortunately, it has a lot of side effects, so it is not one of my favorites. It can cause blurred vision, dry mouth, confusion, and urinary retention. It is strictly contraindicated in people who suffer from glaucoma because it can worsen the condition. Alcohol must be avoided when taking Scopolamine. Alternative types of treatment may yield marginal results. One study has shown that one to two grams of ginger may help. Acupressure has little scientific evidence supporting its usage. Most importantly, it is essential to keep visual clues in line with the stimulatory clues. Conditioning is important, but remember that some safe medications are available to prevent discomfort. If you have an impending trip, such as a cruise, seek medical advice. Also, if affected on a cruise, seek the assistance of on board medical personnel who will be familiar with motion sickness and able to assist you. |
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