Editing Motion sickness

{{Short description|Nausea caused by motion or perceived motion}}
{{other uses|Motion Sickness (disambiguation)}}
{{Infobox medical condition (new)
| name            = Motion sickness
| synonyms        = Kinetosis, travel sickness, mal de mer, seasickness, [[airsickness]], carsickness, simulation sickness, space motion sickness, [[space adaptation syndrome]]
| image           = Sea-sickness - published by G.S. Tregear, 96 Cheapside (cropped).jpg
| caption         = A drawing of people with seasickness from 1841
| pronounce       =
| field           = [[Neurology]]
| symptoms        = [[Nausea]], [[vomiting]], cold sweat, increased [[salivation]]<ref name=HaleStanney2014/><ref name=Stat2019/>
| complications   = [[Dehydration]], [[electrolyte problems]], [[lower esophageal tear]]<ref name=Stat2019/>
| onset           =
| duration        =
| types           =
| causes          = Real or perceived motion<ref name=HaleStanney2014/><ref name=Stat2019/>
| risks           = [[Pregnancy]], [[migraines]], [[Ménière's disease]]<ref name=Stat2019/>
| diagnosis       = Based on symptoms<ref name=Stat2019/>
| differential    = [[Benign paroxysmal positional vertigo]], [[vestibular migraine]], [[stroke]]<ref name=Stat2019/>
| prevention      = Avoidance of triggers<ref name=Stat2019/>
| treatment       = Behavioral measures, medications<ref name=Gold2016/>
| medication      = [[Hyoscine|Scopolamine]], [[dimenhydrinate]], [[dexamphetamine]]<ref name=Gold2016/>
| prognosis       = Generally resolve within a day<ref name=Stat2019/>
| frequency       = Nearly all people with sufficient motion; roughly one-third highly susceptible<ref name=Gold2016/>
| deaths          =
}}
'''Motion sickness''' occurs due to a difference between actual and expected motion.<ref name=HaleStanney2014/><ref name=Stat2019/><ref name=ReasonBrand1975/> Symptoms commonly include [[nausea]], [[vomiting]], cold sweat, headache, [[dizziness]], tiredness, loss of appetite, and increased [[salivation]].<ref name=HaleStanney2014/><ref name=Hromatka2015>{{cite journal |last1=Hromatka |first1=Bethann S. |last2=Tung |first2=Joyce Y. |last3=Kiefer |first3=Amy K. |last4=Do |first4=Chuong B. |last5=Hinds |first5=David A. |last6=Eriksson |first6=Nicholas |title=Genetic variants associated with motion sickness point to roles for inner ear development, neurological processes and glucose homeostasis |journal=Human Molecular Genetics |date=1 May 2015 |volume=24 |issue=9 |pages=2700–2708 |doi=10.1093/hmg/ddv028 |pmid=25628336 |pmc=4383869 }}</ref> Complications may rarely include [[dehydration]], [[electrolyte problems]], or a [[lower esophageal tear]].<ref name=Stat2019/>

The cause of motion sickness is either real or perceived motion.<ref name=Stat2019/> This may include car travel, air travel, sea travel, [[space adaptation syndrome|space travel]], or [[reality simulation]].<ref name=Stat2019/> Risk factors include [[pregnancy]], [[migraines]], and [[Ménière's disease]].<ref name=Stat2019/> The diagnosis is based on symptoms.<ref name=Stat2019/>

Treatment may include behavioral measures or medications.<ref name=Gold2016/> Behavioral measures include keeping the head still and focusing on the [[horizon]].<ref name=Hemmerich2020/><ref name=Munafo2016/> Three types of medications are useful: [[antimuscarinics]] such as [[Hyoscine|scopolamine]], [[H1 antihistamine|H<sub>1</sub> antihistamines]] such as [[dimenhydrinate]], and [[amphetamines]] such as [[dexamphetamine]].<ref name=Gold2016>{{Cite book|last=Golding|first=J. F.|title=Neuro-Otology |date=2016|chapter=Motion sickness|series=Handbook of Clinical Neurology|volume=137|pages=371–390|doi=10.1016/B978-0-444-63437-5.00027-3|issn=0072-9752|pmid=27638085|isbn=9780444634375}}</ref> Side effects, however, may limit the use of medications.<ref name=Gold2016/> A number of medications used for nausea such as [[ondansetron]] are not effective for motion sickness.<ref name=Gold2016/>

Many people can be affected with sufficient motion<ref name=Stat2019/> and some people will experience motion sickness at least once in their lifetime.<ref name=Herron2010/> Susceptibility, however, is variable, with about one-third of the population being susceptible while other people can be affected only under very extreme conditions.<ref name=Stat2019/> Women can be more easily affected than men.<ref name=Hemmerich2019/> Motion sickness has been described since at least the time of [[Homer]] ({{circa}} eighth century BC).<ref name=Huppert2017/>
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==Signs and symptoms==
Symptoms commonly include [[nausea]], [[vomiting]], cold sweat, headache, [[dizziness]], tiredness, loss of appetite, and increased [[salivation]].<ref name=Stat2019/><ref name=Hromatka2015/> Occasionally, tiredness can last for hours to days after an episode of motion sickness, known as "[[sopite syndrome]]".<ref name=Stat2019/> Rarely severe symptoms such as the inability to walk, ongoing vomiting, or social isolation may occur while rare complications may include [[dehydration]], [[electrolyte problems]], or a [[lower esophageal tear]] from severe vomiting.<ref name=Stat2019/>

==Cause==
Motion sickness can be divided into three categories:{{citation needed|date=July 2021}}
# Motion sickness caused by motion that is felt but not seen i.e. terrestrial motion sickness;
# Motion sickness caused by motion that is seen but not felt i.e. space motion sickness;
# Motion sickness caused when both systems detect motion but they do not correspond i.e. either terrestrial or space motion sickness.

===Motion felt but not seen===
In these cases, motion is sensed by the [[vestibular system]] and hence the motion is felt, but no motion or little motion is detected by the [[visual system]], as in terrestrial motion sickness.{{citation needed|date=August 2021}}

====Carsickness====
{{more citations needed|section|date=February 2018}}
A specific form of [[wikt:terrestrial|terrestrial]] motion sickness, being carsick is quite common and evidenced by disorientation while reading a map, a book, or a small screen during travel. Carsickness results from the sensory conflict arising in the brain from differing sensory inputs. Motion sickness is caused by a conflict between signals arriving in the [[brain]] from the inner [[ear]], which forms the base of the [[vestibular system]], the sensory apparatus that deals with movement and balance, and which detects motion mechanically. If someone is looking at a stationary object within a vehicle, such as a magazine, their eyes will inform their brain that what they are viewing is not moving. Their inner ears, however, will contradict this by sensing the motion of the vehicle.<ref name="economist2018"/>

Varying theories exist as to cause. The sensory conflict theory notes that the eyes view motion while riding in the moving vehicle while other body sensors sense stillness, creating conflict between the eyes and inner ear. Another suggests the eyes mostly see the interior of the car which is motionless while the [[vestibular system]] of the inner ear senses motion as the vehicle goes around corners or over hills and even small bumps. Therefore, the effect is worse when looking down but may be lessened by looking outside of the vehicle.

In the early 20th century, Austro-Hungarian scientist [[Róbert Bárány]] observed the back and forth movement of the eyes of railroad passengers as they looked out the side windows at the scenery whipping by. He called this "railway [[nystagmus]]", also known as "optokinetic nystagmus". His findings were published in the journal ''Laeger'', 83:1516, Nov.17, 1921.

====Airsickness====
{{Main|Airsickness}}
Air sickness is a kind of terrestrial motion sickness induced by certain sensations of air travel.<ref name="Benson 2002" /> It is a specific form of motion sickness and is considered a normal response in healthy individuals. It is essentially the same as carsickness but occurs in an airplane. An airplane may bank and tilt sharply, and unless passengers are sitting by a window, they are likely to see only the stationary interior of the plane due to the small window sizes and during flights at night. Another factor is that while in flight, the view out of windows may be blocked by clouds, preventing passengers from seeing the moving ground or passing clouds.{{citation needed|date=July 2021}}

====Seasickness====
Seasickness is a form of terrestrial motion sickness characterized by a feeling of [[nausea]] and, in extreme cases, [[vertigo]] experienced after spending time on a boat.<ref name="Benson 2002"/>  It is essentially the same as carsickness, though the motion of a watercraft tends to be more regular. It is typically brought on by the rocking motion of the craft<ref name="Gahlinger 2000" /><ref name="Sharma1992" /> or movement while the craft is immersed in water.<ref name="Norfleet et al 1992" /> As with airsickness, it can be difficult to visually detect motion even if one looks outside the boat since water does not offer fixed points with which to visually judge motion. Poor visibility conditions, such as fog, may worsen seasickness. The greatest contributor to seasickness is the tendency for people being affected by the rolling or surging motions of the craft to seek refuge below decks, where they are unable to relate themselves to the boat's surroundings and consequent motion. Some people with carsickness are resistant to seasickness and vice versa.{{citation needed|date=February 2017}} Adjusting to the craft's motion at sea is called "gaining one's sea legs"; it can take a significant portion of the time spent at sea after disembarking to regain a sense of stability "post-sea legs".

====Centrifuge motion sickness====
Rotating devices such as [[Centrifuge#Aeronautics and astronautics|centrifuges]] used in astronaut training and amusement park rides such as the [[Rotor (ride)|Rotor]], [[Mission: Space]] and the [[Gravitron]] can cause motion sickness in many people.  While the interior of the centrifuge does not appear to move, one will experience a sense of motion.{{dubious|reason= this language confounds both forms of motion and sensations of motion; see talk-page section "confoundings"|date=March 2018}} In addition, [[centrifugal force]] can cause the vestibular system to give one the sense that downward is in the direction away from the center of the centrifuge rather than the true downward direction.<ref>{{Cite journal |last1=Bertolini |first1=Giovanni |last2=Straumann |first2=Dominik |date=2016 |title=Moving in a Moving World: A Review on Vestibular Motion Sickness |journal=Frontiers in Neurology |volume=7 |page=14 |doi=10.3389/fneur.2016.00014 |issn=1664-2295 |pmc=4753518 |pmid=26913019|doi-access=free }}</ref>

====Dizziness due to spinning====
When one spins and stops suddenly, fluid in the inner ear continues to rotate causing a sense of continued spinning while one's visual system no longer detects motion.{{citation needed|date=July 2021}}

====Virtual reality====
{{Main|Virtual reality sickness}}
Usually, VR programs would detect the motion of the user's head and adjust the rotation of vision to avoid dizziness. However, some cases such as system lagging or software crashing could cause lags in the screen updates. In such cases, even some small head motions could trigger the motion sickness by the [[Defence mechanism|defense mechanism]] mentioned below: the [[inner ear]] transmits to the brain that it senses motion, but the eyes tell the brain that everything is still.

===Motion seen but not felt===
In these cases, motion is detected by the [[visual system]] and hence the motion is seen, but no motion or little motion is sensed by the [[vestibular system]]. Motion sickness arising from such situations has been referred to as "visually induced motion sickness" (VIMS).<ref name="So and Ujike 2010" />

====Space motion sickness====
{{Main|Space adaptation syndrome}}
Zero gravity interferes with the vestibular system's gravity-dependent operations, so that the two systems, vestibular and visual, no longer provide a unified and coherent sensory representation. This causes unpleasant disorientation sensations often quite distinct from terrestrial motion sickness, but with similar symptoms. The symptoms may be more intense because a condition caused by prolonged weightlessness is usually quite unfamiliar.{{citation needed|date=July 2021}}

Space motion sickness was effectively unknown during the earliest spaceflights because the very cramped conditions of the spacecraft allowed for only minimal bodily motion, especially head motion. Space motion sickness seems to be aggravated by being able to freely move around, and so is more common in larger spacecraft.<ref name="Benson 2002" /> Around 60% of [[Space Shuttle]] astronauts experienced it on their first flight; the first case of space motion sickness is now thought to be the Soviet [[cosmonaut]] [[Gherman Titov]], in August 1961 onboard ''[[Vostok 2]]'', who reported dizziness, nausea, and vomiting. The first severe cases were in early Apollo flights; [[Frank Borman]] on ''[[Apollo 8]]'' and [[Rusty Schweickart]] on ''[[Apollo 9]]''. Both experienced identifiable and quite unpleasant symptoms—in the latter case causing the mission plan to be modified.{{citation needed|date=July 2021}}

====Screen images====
This type of terrestrial motion sickness is particularly prevalent when susceptible people are watching films presented on very large screens such as [[IMAX]], but may also occur in regular format theaters or even when watching TV or playing games.  For the sake of novelty, IMAX and other panoramic type theaters often show dramatic motions such as flying over a landscape or riding a [[roller coaster]].

In regular-format theaters, an example of a movie that caused motion sickness in many people is ''[[The Blair Witch Project]]''.  Theaters warned patrons of its possible nauseating effects, cautioning pregnant women in particular.  ''Blair Witch'' was filmed with a handheld [[camcorder]], which was subjected to considerably more motion than the average movie camera,<ref name="Wax" /> and lacks the stabilization mechanisms of [[steadicam]]s.

Home movies, often filmed with a cell phone camera, also tend to cause motion sickness in those who view them.  The person holding the cell phone or other camera usually is unaware of this as the recording is being made since the sense of motion seems to match the motion seen through the camera's viewfinder.  Those who view the film afterward only see the movement, which may be considerable, without any sense of motion.  Using the zoom function seems to contribute to motion sickness as well since zooming is not a normal function of the eye.  The use of a tripod or a camera or cell phone with [[image stabilization]] while filming can reduce this effect.{{nosource|date=August 2017}}

====Virtual reality====
{{See also|Virtual reality sickness}}
Motion sickness due to [[virtual reality]] is very similar to simulation sickness and motion sickness due to films.<ref name="ARVI"/>  In virtual reality the effect is made more acute as all external reference points are blocked from vision, the simulated images are [[Stereoscopy|three-dimensional]] and in some cases stereo sound that may also give a sense of motion. The NADS-1, a simulator located at the [[National Advanced Driving Simulator]], is capable of accurately stimulating the vestibular system with a 360-degree horizontal field of view and 13 degrees of freedom motion base.<ref name="NADS"/> Studies have shown that exposure to rotational motions in a virtual environment can cause significant increases in nausea and other symptoms of motion sickness.<ref name="SoLo1999"/>

In a study conducted by the U.S. Army Research Institute for the Behavioral and Social Sciences in a report published May 1995 titled "Technical Report 1027 – Simulator Sickness in Virtual Environments", out of 742 pilot exposures from 11 military flight simulators, "approximately half of the pilots (334) reported post-effects of some kind: 250 (34%) reported that symptoms dissipated in less than one hour, 44 (6%) reported that symptoms lasted longer than four hours, and 28 (4%) reported that symptoms lasted longer than six hours. There were also four (1%) reported cases of spontaneously occurring flashbacks."<ref name="cyberedge" />

===Motion that is seen and felt===

When moving within a rotating reference frame such as in a centrifuge or environment where [[Rotational gravity|gravity is simulated]] with centrifugal force, the [[coriolis effect]] causes a sense of motion in the vestibular system that does not match the motion that is seen.{{citation needed|date=July 2021}}

==Pathophysiology==
There are various hypotheses that attempt to explain the cause of the condition.

=== Sensory conflict theory ===
Contemporary sensory conflict theory, referring to "a discontinuity between either visual, proprioceptive, and somatosensory input, or semicircular canal and otolith input", is probably the most thoroughly studied.<ref>{{Cite journal |pmid = 6870740|year = 1983|last1 = Kohl|first1 = R. L.|title = Sensory conflict theory of space motion sickness: An anatomical location for the neuroconflict|journal = Aviation, Space, and Environmental Medicine|volume = 54|issue = 5|pages = 464–5}}</ref> According to this theory, when the brain presents the mind with two incongruous states of motion, the result is often nausea and other symptoms of disorientation known as motion sickness.{{why|reason=This restates the causes section without explaining why the body responds in this way.|date=April 2024}} Such conditions happen when the [[vestibular system]] and the [[visual system]] do not present a synchronized and unified representation of one's body and surroundings.<ref>{{Cite web |title=How To Cure Motion Sickness Permanently |url=https://curemotionsickness.com/ |access-date=2022-11-16 |website=Captain Arthur's |language=en-US}}</ref>

According to sensory conflict theory, the cause of terrestrial motion sickness is the opposite of the cause of space motion sickness. The former occurs when one perceives visually that one's surroundings are relatively immobile while the [[vestibular system]] reports that one's body is in motion relative to its surroundings.<ref name="Benson 2002" /> The latter can occur when the visual system perceives that one's surroundings are in motion while the vestibular system reports relative bodily immobility (as in zero gravity.){{citation needed|date=July 2021}}

=== Neural mismatch ===
A variation of the sensory conflict theory is known as neural mismatch, implying a mismatch occurring between ongoing sensory experience and long-term memory rather than between components of the vestibular and visual systems. This theory emphasizes "the limbic system in the integration of sensory information and long-term memory, in the expression of the symptoms of motion sickness, and the impact of anti-motion-sickness drugs and stress hormones on limbic system function. The limbic system may be the neural mismatch center of the brain."<ref>{{Cite journal |pmc = 4112051|year = 2014|last1 = Lackner|first1 = J. R.|title = Motion sickness: More than nausea and vomiting|journal = Experimental Brain Research|volume = 232|issue = 8|pages = 2493–2510|pmid = 24961738|doi = 10.1007/s00221-014-4008-8}}</ref>

=== Defense against poisoning ===
It has also been proposed that motion sickness could function as a defense mechanism against [[neurotoxin]]s.<ref name="Treisman1977" /> The [[area postrema]] in the [[human brain|brain]] is responsible for inducing vomiting when poisons are detected, and for resolving conflicts between vision and balance. When feeling motion but not seeing it (for example, in the cabin of a ship with no portholes), the [[inner ear]] transmits to the brain that it senses motion, but the eyes tell the brain that everything is still. As a result of the incongruity, the brain concludes that the individual is [[hallucination|hallucinating]] and further concludes that the hallucination is due to poison ingestion. The brain responds by inducing vomiting, to clear the supposed toxin. Treisman's indirect argument has recently been questioned via an alternative direct evolutionary hypothesis, as well as modified and extended via a direct poison hypothesis.<ref name="Lawson 20142"/> The direct evolutionary hypothesis essentially argues that there are plausible means by which ancient real or apparent motion could have contributed directly to the evolution of aversive reactions, without the need for the co-opting of a poison response as posited by Treisman. Nevertheless, the direct poison hypothesis argues that there still are plausible ways in which the body's poison response system may have played a role in shaping the evolution of some of the signature symptoms that characterize motion sickness.{{citation needed|date=July 2021}}

=== Nystagmus hypothesis ===
Yet another theory, known as the nystagmus hypothesis,<ref name="Ebenholtz et al 1994" /> has been proposed based on stimulation of the [[vagus nerve]] resulting from the stretching or traction of extra-ocular muscles co-occurring with eye movements caused by vestibular stimulation. There are three critical aspects to the theory: first is the close linkage between activity in the vestibular system, i.e., [[semicircular canals]] and [[Otolith|otolith organs]], and a change in tonus among various of each eye's six extra-ocular muscles. Thus, with the exception of voluntary eye movements, the vestibular and oculomotor systems are thoroughly linked. Second is the operation of [[Sherrington's law of reciprocal innervation|Sherrington's Law]]<ref name="Sherrington1893" /> describing reciprocal inhibition between agonist-antagonist muscle pairs, and by implication the stretching of [[Extraocular muscles|extraocular muscle]] that must occur whenever Sherrington's Law is made to fail, thereby causing an unrelaxed (contracted) muscle to be stretched. Finally, there is the critical presence of afferent output to the Vagus nerves as a direct result of eye muscle stretch or traction.<ref name="pmid6671149" /> Thus, tenth nerve stimulation resulting from eye muscle stretch is proposed as the cause of motion sickness. The theory explains why labyrinthine-defective individuals are immune to motion sickness;<ref name="Kennedy et al 1968" /><ref name="pmid1859339" /> why symptoms emerge when undergoing various body-head accelerations; why combinations of voluntary and reflexive eye movements may challenge the proper operation of Sherrington's Law, and why many drugs that suppress eye movements also serve to suppress motion sickness symptoms.<ref name="Ebenholtz 2005" />

A recent theory <ref name="Previc 2018" /> argues that the main reason motion sickness occurs is due to an imbalance in vestibular outputs favoring the semicircular canals ([[nauseogenic]]) vs. [[otolith]] organs (anti-nauseogenic). This theory attempts to integrate previous theories of motion sickness. For example, there are many sensory conflicts that are associated with motion sickness and many that are not, but those in which canal stimulation occurs in the absence of normal otolith function (e.g., in [[free fall]]) are the most provocative. The vestibular imbalance theory is also tied to the different roles of the otoliths and canals in autonomic arousal (otolith output more sympathetic).{{citation needed|date=July 2021}}

==Diagnosis==
The diagnosis is based on symptoms.<ref name=Stat2019/> Other conditions that may present similarly include [[vestibular disorders]] such as [[benign paroxysmal positional vertigo]] and [[vestibular migraine]] and [[stroke]].<ref name=Stat2019/>

== Treatment ==

Treatment may include behavioral measures or medications.<ref name=Gold2016/>

=== Behavioral measures ===
Behavioral measures to decrease motion sickness include holding the head still and lying on the back.<ref name=Gold2016/> Focusing on the horizon may also be useful.<ref name=Stat2019/> Listening to music, mindful breathing, being the driver, and not reading while moving are other techniques.<ref name=Stat2019/>

[[Habituation]] is the most effective technique but requires significant time.<ref name=Stat2019/> It is often used by the military for pilots.<ref name=Stat2019/> These techniques must be carried out at least every week to retain effectiveness.<ref name=Stat2019/>

A head-worn, computer device with a transparent display can be used to mitigate the effects of motion sickness (and [[spatial disorientation]]) if visual indicators of the wearer's head position are shown.<ref name="pmid21181963"/> Such a device functions by providing the wearer with digital reference lines in their field of vision that indicate the horizon's position relative to the user's head. This is accomplished by combining readings from [[accelerometers]] and [[gyroscopes]] mounted in the device. This technology has been implemented in both standalone devices<ref name="biz"/> and [[Google Glass]].<ref name="BCM"/><ref name="glass"/> One promising looking treatment is to wear LCD shutter glasses that create a [[Stroboscopic effect|stroboscopic]] vision of 4&nbsp;Hz with a dwell of 10 milliseconds.<ref name="ntrs" >{{cite journal |last1=Reschke |first1=MF |last2=Somers |first2=JT |last3=Ford |first3=G |title=Stroboscopic vision as a treatment for motion sickness: strobe lighting vs. shutter glasses. |journal=Aviation, Space, and Environmental Medicine |date=January 2006 |volume=77 |issue=1 |pages=2–7 |pmid=16422446}}</ref>

=== Medication ===
Three types of medications are sometimes prescribed to improve symptoms of motion sickness: [[antimuscarinics]] such as [[Hyoscine|scopolamine]], [[H1 antihistamine|H<sub>1</sub> antihistamines]] such as [[dimenhydrinate]], and [[amphetamines]] such as [[dexamphetamine]].<ref name=Gold2016/> Benefits are greater if used before the onset of symptoms or shortly after symptoms begin.<ref name=Stat2019/> Side effects, however, may limit the use of medications.<ref name=Gold2016/> A number of medications used for nausea such as [[ondansetron]] and [[metoclopramide]] are not effective in motion sickness.<ref name=Gold2016/><ref name=Stat2019/>

==== Scopolamine (antimuscarinic) ====
Scopolamine is the most effective medication.<ref name="Stat2019" /> Evidence is best for when it is used preventatively.<ref name="Spinks2011">{{cite journal |vauthors=Spinks A, Wasiak J |title=Scopolamine (hyoscine) for preventing and treating motion sickness |journal=The Cochrane Database of Systematic Reviews |issue=6 |pages=1–21 |year=2011 |volume=2007 |pmid=21678338 |doi=10.1002/14651858.CD002851.pub4 |pmc=7138049 |hdl=10072/19480 |hdl-access=free }}</ref> It is available as a [[transdermal patch|skin patch]].<ref name="Stat2019" /> Side effects may include blurry vision.<ref name="Stat2019" />

==== Antihistamines ====
First generation [[H1 antagonist|H1 antihistamine]] medications are sometimes given to prevent or treat motion sickness. This class of medication is often effective at reducing the risk of getting motion sickness while in motion, however, the effectiveness of antihistamines at treating or stopping motion sickness once a person is already experiencing it has not been well studied.<ref name=":0">{{Cite journal |last1=Karrim |first1=Nadine |last2=Byrne |first2=Ryan |last3=Magula |first3=Nombulelo |last4=Saman |first4=Yougan |date=2022-10-17 |title=Antihistamines for motion sickness |url= |journal=The Cochrane Database of Systematic Reviews |volume=2022 |issue=10 |pages=CD012715 |doi=10.1002/14651858.CD012715.pub2 |issn=1469-493X |pmc=9575651 |pmid=36250781 }}</ref> Effective first generation antihistamines include [[doxylamine]], [[diphenhydramine]], [[promethazine]], [[meclizine]], [[cyclizine]], and [[cinnarizine]].<ref name="Stat2019" /> In pregnancy meclizine, dimenhydrinate and doxylamine are generally felt to be safe.<ref name="Stat2019" /> Side effects include sleepiness.<ref name="Stat2019" /><ref name=":0" /> [[Second generation antihistamines]] have not been found to be useful.<ref name="Stat2019" />

Some, but not all, antihistamines used for motion sickness are also antimuscarinics.<ref name="Stat2019" />

==== Amphetamines ====
Dextroamphetamine may be used together with an antihistamine or an antimuscarinic with synergistic effects.<ref name=Stat2019/> Concerns include their addictive potential.<ref name=Stat2019/>

Those involved in high-risk activities, such as SCUBA diving, should evaluate the risks versus the benefits of medications.<ref name="Schwartz and Curley1986" /><ref name="Lawson et al 2009" /><ref name="Bitterman et al 1991" /><ref name="Williams et al 1988" /><ref name="Arieli et al 1999" /> Promethazine combined with [[ephedrine]] to counteract the sedation is known as "the Coast Guard cocktail".<ref name="ECU" />

===Alternative medicine===
Alternative treatments include [[acupuncture]] and [[ginger]], although their effectiveness against motion sickness is variable.<ref name=Gold2016/><ref>{{cite journal |last1=Stern |first1=RM |last2=Jokerst |first2=MD |last3=Muth |first3=ER |last4=Hollis |first4=C |title=Acupressure relieves the symptoms of motion sickness and reduces abnormal gastric activity |journal=Alternative Therapies in Health and Medicine |date=Jul–Aug 2001 |volume=7 |issue=4 |pages=91–94 |pmid=11452572 |url=https://pubmed.ncbi.nlm.nih.gov/11452572/}}</ref><ref name="Brainard et al 2014" /><ref>{{cite journal |last1=Han-Chung |first1=Lien |last2=Wei Ming |first2=Sun |last3=Yen-Hsueh |first3=Chen |last4=Hyerang |first4=Kim |last5=William |first5=Hasler |last6=Chung |first6=Owyang |title=Effects of ginger on motion sickness and gastric slow-wave dysrhythmias induced by circular vection |journal=American Journal of Physiology. Gastrointestinal and Liver Physiology |date=11 March 2003 |volume=284 |issue=3 |pages=481–489 |doi=10.1152/ajpgi.00164.2002 |pmid=12576305 |url=https://pubmed.ncbi.nlm.nih.gov/12576305/}}</ref> Providing smells does not appear to have a significant effect on the rate of motion sickness.<ref name=Gold2016/>

==Epidemiology==
Roughly one-third of people are highly susceptible to motion sickness, and most of the rest get motion sick under extreme conditions. Around 80% of the general population is susceptible to cases of medium to high motion sickness. The rates of space motion sickness have been estimated at between forty and eighty percent of those who enter weightless orbit. Several factors influence susceptibility to motion sickness, including sleep deprivation and the cubic footage allocated to each space traveler. Studies indicate that women are more likely to be affected than men,<ref name=Stat2019/> and that the risk decreases with advancing age. There is some evidence that people with Asian ancestry may develop motion sickness more frequently than people of European ancestry, and there are situational and behavioral factors, such as whether a passenger has a view of the road ahead, and diet and eating behaviors.<ref name="pmid25628336"/>

== See also ==
* [[Mal de debarquement]] - disembarkment syndrome, usually follows a cruise or other motion experience

==References==
{{Reflist|refs=

<ref name="Arieli et al 1999">{{cite journal |vauthors=Arieli R, Shupak A, Shachal B, Shenedrey A, Ertracht O, Rashkovan G |title=Effect of the anti-motion-sickness medication cinnarizine on central nervous system oxygen toxicity |journal=Undersea and Hyperbaric Medicine |volume=26 |issue=2 |pages=105–09 |year=1999 |pmid=10372430 |url=http://archive.rubicon-foundation.org/2307 |archive-url=https://web.archive.org/web/20081007192648/http://archive.rubicon-foundation.org/2307 |url-status=usurped |archive-date=October 7, 2008 |access-date=2008-05-09}}</ref>

<ref name="ARVI">{{Cite news|url=https://vr.arvilab.com/blog/combating-vr-sickness-debunking-myths-and-learning-what-really-works|title=Combating VR Sickness: Debunking Myths And Learning What Really Works|work=ARVI Games}}</ref>

<ref name="BCM">{{cite web|title=BCMC, LLC|url=http://www.bcmcllc.com|access-date=15 July 2014}}</ref>

<ref name="Benson 2002">{{cite book |first=Alan J. |last=Benson |editor=Kent B. Pandoff |editor2=Robert E. Burr |title=Medical Aspects of Harsh Environments |volume=2 |chapter=Motion Sickness |publisher=[[Borden Institute]] |location=[[Washington, D.C.]] |year=2002 |chapter-url=http://apps.dtic.mil/dtic/tr/fulltext/u2/a433963.pdf |access-date=27 Mar 2017 |pages=1048–83 |isbn=978-0-16-051184-4 |archive-date=2 October 2022 |archive-url=https://web.archive.org/web/20221002064430/https://apps.dtic.mil/dtic/tr/fulltext/u2/a433963.pdf |url-status=dead }}</ref>

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<ref name="biz">{{cite news|title=Air Force to examine AdviTech's motion-sickness product for combat pilots|url=http://www.bizjournals.com/sanantonio/news/2010/11/10/air-force-to-examine-advitechs.html|access-date=15 July 2014|newspaper=San Antonio Business Journal|date=Nov 10, 2010}}</ref>

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<ref name="cyberedge">{{Cite web |url=http://www.cyberedge.com/info_r_a+p05_ss-es.html |title=CyberEdge Information Services: Health & Safety, Simulator Sickness in Virtual Environments: Executive Summary |access-date=2007-05-29 |archive-url=https://web.archive.org/web/20071009161955/http://www.cyberedge.com/info_r_a+p05_ss-es.html |archive-date=2007-10-09 |url-status=dead }}</ref>

<ref name="Ebenholtz 2005">Ebenholtz, S.M.Oculomotor Systems and Perception. Cambridge University Press, 2005, 148–53</ref>

<ref name="Ebenholtz et al 1994">{{cite journal | vauthors = Ebenholtz SM, Cohen MM, Linder BJ | title = The possible role of nystagmus in motion sickness: a hypothesis | journal = Aviat Space Environ Med | volume = 65 | issue = 11 | pages = 1032–35 | date = November 1994 | pmid = 7840743}}</ref>

<ref name="economist2018">{{Cite news|url=https://www.economist.com/news/science-and-technology/21736125-way-deal-motion-sickness-preventing-passengers-autonomous-cars|title=Preventing passengers in autonomous cars from feeling queasy|newspaper=The Economist|language=en|access-date=2018-02-05|date=2018-02-01}}</ref>

<ref name="ECU">{{cite web|url=http://www.ecu.edu/cs-acad/diving/upload/Seasickness-Information-and-Treatment.pdf|title=Seasickness: Information and Treatment|author=(([[East Carolina University]] Department of Diving & Water Safety))|access-date=2017-02-07|archive-date=2017-08-29|archive-url=https://web.archive.org/web/20170829232339/http://www.ecu.edu/cs-acad/diving/upload/Seasickness-Information-and-Treatment.pdf|url-status=dead}}</ref>

<ref name="Gahlinger 2000">{{cite journal |last=Gahlinger |first=P. M. |title=A comparison of motion sickness remedies in severe sea conditions |journal=Wilderness Environ Med |volume=11 |issue=2 |pages=136–37 |year=2000 |pmid=10921365 |doi=10.1580/1080-6032(2000)011[0136:LTTE]2.3.CO;2|doi-access=free }}</ref>

<ref name="glass">{{cite web|title=Google Glass Treating Motion Sickness|url=https://www.youtube.com/watch?v=xLUCsuMGCqE| archive-url=https://ghostarchive.org/varchive/youtube/20211113/xLUCsuMGCqE| archive-date=2021-11-13 | url-status=live|website=YouTube | date=15 May 2014 |access-date=15 July 2014}}{{cbignore}}</ref>

<ref name="Hemmerich2019">{{cite journal | last1=Hemmerich | first1=Wanja A. | last2=Shahal | first2=Avner | last3=Hecht | first3=Heiko | title=Predictors of visually induced motion sickness in women | journal=Displays | publisher=Elsevier BV | volume=58 | year=2019 | issn=0141-9382 | doi=10.1016/j.displa.2018.11.005 | pages=27–32| s2cid=115757932 }}</ref>

<ref name="HaleStanney2014">{{cite book | first1 = Behrang | last1 = Keshavarz | first2 = Heiko | last2 = Hecht | first3 = Ben | last3 = Lawson| editor-last1=Hale | editor-first1=K.S. | editor-last2=Stanney | editor-first2=K.M. | title=Handbook of Virtual Environments: Design, Implementation, and Applications, Second Edition | publisher=Taylor & Francis | series=Human Factors and Ergonomics | year=2014 | chapter=Visually induced motion sickness: Characteristics, causes, and countermeasures | isbn=978-1-4665-1184-2 | url=https://books.google.com/books?id=XihZBAAAQBAJ | access-date=2021-11-13 | pages=648–697}}</ref>

<ref name="Hemmerich2020">{{cite journal | last1=Hemmerich | first1=Wanja | last2=Keshavarz | first2=Behrang | last3=Hecht | first3=Heiko | title=Visually Induced Motion Sickness on the Horizon | journal=Frontiers in Virtual Reality | publisher=Frontiers Media SA | volume=1 | date=2020-11-24 | issn=2673-4192 | doi=10.3389/frvir.2020.582095 | page=| doi-access=free }}</ref>

<ref name="Herron2010">{{cite journal | last=Herron | first=Dorothy G. | title=The Ups and Downs of Motion Sickness | journal=The American Journal of Nursing | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=110 | issue=12 | year=2010 | issn=0002-936X | pmid=21107067 | doi=10.1097/01.naj.0000391242.75887.17 | pages=49–51| s2cid=17695817 | url=http://libres.uncg.edu/ir/uncg/f/D_Herron_Ups_2010.pdf }}</ref>

<ref name="Huppert2017">{{cite journal | last1=Huppert | first1=Doreen | last2=Benson | first2=Judy | last3=Brandt | first3=Thomas | title=A Historical View of Motion Sickness—A Plague at Sea and on Land, Also with Military Impact | journal=Frontiers in Neurology | publisher=Frontiers Media SA | volume=8 | date=2017-04-04 | issn=1664-2295 | pmid=28421029 | pmc=5378784 | doi=10.3389/fneur.2017.00114 | page=114| doi-access=free }}</ref>

<ref name="Kennedy et al 1968">{{cite journal |last1=Kennedy |first1=R.S. |last2=Graybiel |first2=A. |last3=McDonough |first3=R.C. |last4=Beckwith |first4=F.D. |title=Symptomatology under storm conditions in the North Atlantic in control subjects and in persons with bilateral labyrinthine defects. |journal=Acta Oto-Laryngologica |year=1968 |volume=66 |issue=1–6 |pages=533–40|doi=10.3109/00016486809126317|pmid=5732654 |hdl=2060/19650024320 |hdl-access=free }}</ref>

<ref name="Lawson et al 2009">{{cite report|last1=Lawson|first1=B. D.|last2=McGee|first2=H. A.|last3=Castaneda|first3=M. A.|last4=Golding|first4=J. F.|last5=Kass|first5=S. J.|last6=McGrath|first6=C. M.|year=2009|title=Evaluation of Several Common Antimotion Sickness Medications and Recommendations Concerning Their Potential Usefulness During Special Operations|work=(No. NAMRL-09-15)|publisher=Naval aerospace medical research laboratory|location=Pensacola, Florida.|url=http://oai.dtic.mil/oai/oai?verb=getRecord&metadataPrefix=html&identifier=ADA511823|access-date=2017-02-07|archive-url=https://web.archive.org/web/20160427090307/http://oai.dtic.mil/oai/oai?verb=getRecord&metadataPrefix=html&identifier=ADA511823|archive-date=2016-04-27|url-status=dead}}</ref>

<ref name="Lawson 20142">Lawson, B. D. (2014). Motion sickness symptomatology and origins. Handbook of Virtual Environments: Design, Implementation, and Applications, 531–99.</ref>

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<ref name="pmid6671149">{{cite journal | vauthors = Milot JA, Jacob JL, Blanc VF, Hardy JF | title = The oculocardiac reflex in strabismus surgery | journal = Can. J. Ophthalmol. | volume = 18 | issue = 7 | pages = 314–17 | date = December 1983 | pmid = 6671149 }}</ref>

<ref name="NADS">{{cite web|url=http://www.nads-sc.uiowa.edu/sim_nads1.php |title=The National Advanced Driving Simulator – The NADS-1 |publisher=Nads-sc.uiowa.edu |access-date=2014-03-02}}</ref>

<ref name="Norfleet et al 1992">{{cite journal |last1=Norfleet |first1=W. T. |last2=Peterson |first2=R. E. |last3=Hamilton |first3=R. W. |last4=Olstad |first4=C. S. |title=Susceptibility of divers in open water to motion sickness |journal=Undersea Biomed Res |volume=19 |issue=1 |pages=41–47 |date=January 1992 |pmid=1536062 |url=http://archive.rubicon-foundation.org/2621 |archive-url=https://web.archive.org/web/20081016051032/http://archive.rubicon-foundation.org/2621 |url-status=usurped |archive-date=October 16, 2008 |access-date=2008-05-09}}</ref>

<ref name="pmid25628336">{{cite journal | vauthors = Hromatka BS, Tung JY, Kiefer AK, Do CB, Hinds DA, Eriksson N | title = Genetic variants associated with motion sickness point to roles for inner ear development, neurological processes and glucose homeostasis | journal = Hum. Mol. Genet. | volume = 24 | issue = 9 | pages = 2700–08 | date = May 2015 | pmid = 25628336 | pmc = 4383869 | doi = 10.1093/hmg/ddv028 }}</ref>

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<ref name="Treisman1977">{{cite journal | last=Treisman | first=Michel | title=Motion Sickness: An Evolutionary Hypothesis | journal=Science | publisher=American Association for the Advancement of Science (AAAS) | volume=197 | issue=4302 | date=1977-07-29 | issn=0036-8075 | doi=10.1126/science.301659 | pages=493–495| pmid=301659 | bibcode=1977Sci...197..493T }}</ref>

<ref name="Wax">{{cite news|last1=Wax|first1=Emily|title=The Dizzy Spell of 'Blair Witch Project'|url=https://www.washingtonpost.com/wp-srv/style/movies/features/witchdizzy.htm|access-date=8 February 2017|newspaper=The Washington Post|date=30 July 1999}}</ref>

<ref name="Williams et al 1988">{{cite journal |vauthors=Williams TH, Wilkinson AR, Davis FM, Frampton CM |title=Effects of transcutaneous scopolamine and depth on diver performance |journal=Undersea Biomedical Research |volume=15 |issue=2 |pages=89–98 |date=March 1988 |pmid=3363755 |url=http://archive.rubicon-foundation.org/2495 |archive-url=https://web.archive.org/web/20080820005139/http://archive.rubicon-foundation.org/2495 |url-status=usurped |archive-date=August 20, 2008 |access-date=2008-05-09}}</ref>

}}

== External links ==
{{Wiktionary}}
{{Commons category}}
* {{cite book |last1=Davis|first1=Christopher J. |last2=Lake-Bakaar|first2=Gerry V.|last3=Grahame-Smith|first3=David G.|title=Nausea and Vomiting: Mechanisms and Treatment |url = https://books.google.com/books?id=ufoqBAAAQBAJ&pg=PA123 |date=2012 |publisher=Springer Science & Business Media |isbn=978-3-642-70479-6 |page = 123 }}
* [https://www.nlm.nih.gov/medlineplus/motionsickness.html Motion Sickness] from [[MedlinePlus]]
{{Medical resources
|  DiseasesDB      = 11908
|  ICD10           = {{ICD10|T|75|3|t|66}}
|  ICD9            = {{ICD9|994.6}}
|  OMIM            = 158280
|  MedlinePlus     =
|  eMedicineSubj   = article
|  eMedicineTopic  = 2060606
|  MeshID          = D009041
}}

{{Motion sickness}}
{{Consequences of external causes}}
{{Underwater diving|divmed}}

{{DEFAULTSORT:Motion Sickness}}
[[Category:Motion sickness| ]]
[[Category:Neurological disorders]]
[[Category:Effects of external causes]]
[[Category:Vomiting]]
[[Category:Wikipedia medicine articles ready to translate]]