Motion sickness
Motion sickness is the mixture of nausea, dizziness and general wretchedness that comes on in a car, on a boat, in a plane or on a fairground ride.
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Medicines commonly prescribed for Motion sickness
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 10 mg cetirizine dihydrochlorideActive substance: cetirizineManufacturer: Laboratorios Cinfa S.A.Prescription requiredDosage form: TABLET, 10 mgActive substance: cetirizineManufacturer: Teva Pharma S.L.U.Prescription requiredDosage form: ORAL SOLUTION/SUSPENSION DROPS, 10 mg cetirizine dihydrochlorideActive substance: cetirizineManufacturer: Retrain, S.A.U.Prescription required
Motion sickness is the mixture of nausea, dizziness and general wretchedness that comes on in a car, on a boat, in a plane or on a fairground ride. It is also called travel sickness or sea sickness, though it has no more to do with the sea than with the back seat of a car. It is neither an illness nor a weakness: it is how a perfectly healthy balance system reacts when the movement it senses does not match what the eyes are seeing. Almost anyone can be made travel sick given enough motion. The good news is that nearly all of it is settled in advance, while you still feel fine, and most of the measures cost nothing at all.
How it starts and how it ends
Nausea is not the first thing to arrive. It usually begins quietly: yawning sets in, you feel sleepy, you lose interest in the conversation, the face goes pale, a cold sweat appears on the forehead and above the lip, and the mouth fills with saliva. Many people at that stage still have no idea what is happening — and that is precisely the moment when it is easiest to do something about it.
Next comes heaviness in the pit of the stomach, then nausea, headache and a sense that everything around is drifting slightly. It can end in vomiting; there is brief relief afterwards, but if the motion continues, the cycle starts again. One less familiar and rather unpleasant feature is the flatness and fatigue that linger for several hours after arriving, long after the nausea has gone.
As a rule everything settles within ten to thirty minutes of the movement stopping. After a long crossing the opposite happens: solid ground carries on swaying for a day or two, which is unpleasant but harmless and passes by itself.
Why it happens and who gets it worse
The brain works out where the body is from three sources at once: the eyes, the inner ear, and signals from muscles and joints. As long as all three agree, all is well. When you read in a car, the eyes see a still page while the inner ear registers every bend and every brake — the accounts disagree, and the brain answers with nausea. The same happens in a cabin with no windows or in an aircraft cabin, where the body is being moved about and the gaze has nothing to hold on to.
The reverse situation also exists: in a virtual reality headset, on a simulator, or in a cinema with a wide screen, the eyes see rapid movement that the body cannot feel. The result is identical.
Children get it most, roughly from the age of two until adolescence, while babies almost never do. Women are affected more often than men, particularly in pregnancy and on certain days of the cycle. People with migraine are a group of their own: motion sickness is many times commoner among them, and a journey often ends not just in nausea but in a headache attack. The tendency runs in families, so "we all get it" is not an exaggeration. And the driver is rarely affected — not from habit, but because they know in advance where the car is about to turn, leaving the brain nothing to be surprised by.
What helps during the journey
The first rule is to look into the distance at something still. The horizon, a far-off hill, the road coming towards you: anything that is not jittering will do. Watching passing cars, roadside posts or oncoming waves does the opposite.
The second is to reduce the movement itself. In a car that means the front seat; on a coach, the rows near the front; on a train, facing the direction of travel; on a plane, the rows by the wing; on a ship, the middle of the vessel and a lower deck. Keep the head still against the headrest — the less it is thrown about, the calmer the inner ear.
The rest is a collection of small things that add up. Fresh cool air: a window cracked open, a vent aimed at the face. Slow deep breathing with the eyes shut. A few sips of cold water, a dry cracker or a mint. Ginger in any form does not work for everyone, but it is harmless and worth a try. Talking, music or an audiobook distracts far better than gritting your teeth in silence. And the things to avoid: reading, looking at a phone, eating heavy or greasy food on the way, and sitting in a stuffy space next to strong smells of petrol, food or perfume. On long trips, stopping every hour or ninety minutes helps — just getting out, walking about and breathing.
Getting ready beforehand
A great deal is decided before you set off. Travelling on an empty stomach is as bad as travelling after a large meal: something light an hour or ninety minutes beforehand is sensible, and greasy or spicy food is best left out. Alcohol the night before, and more so during the journey itself, makes matters noticeably worse, and being short of sleep makes them worse still, so a good night's rest before a long trip is more useful than any tablet.
Choose your seat in advance rather than taking whatever is left: on a ferry, a cabin amidships; on a coach, the front rows. Take water, a bag in case of vomiting, wipes and a spare T-shirt — with children that is not over-caution, it is ordinary foresight.
If you are always badly affected, it is worth getting the body used to movement in small doses: short journeys, swings, gentle rides, a boat trip in calm weather. The balance system does train, and in most adults tolerance improves over time. It is not quick, but it works more reliably than anything else on offer.
What you can buy at a pharmacy
Medicines for motion sickness work by getting in first: they are taken half an hour to an hour before setting off, not once the nausea has started. That is the single most important thing to know about them, because a tablet swallowed in the middle of an attack achieves far less.
The mainstay is the sedating antihistamines, among them cinnarizine, dimenhydrinate and meclozine. They are sold without prescription and come in forms suitable for children. The shared side effect is drowsiness, so nobody drives after taking them and they do not go with alcohol. The other option is a hyoscine patch, stuck behind the ear some hours before travelling; it lasts several days and is convenient on a cruise. In return it causes a dry mouth, sometimes blurred vision and sleepiness; wash your hands after applying it so that none reaches an eye, and it is not used in glaucoma or where passing urine is already difficult. Age limits differ from product to product and are given in the leaflet — for children it is worth asking the pharmacist or a doctor, and in pregnancy any of these is taken only on medical advice.
Wristbands that press on a point on the wrist are harmless, but there is no convincing evidence that they do anything. One more point: the usual remedies for nausea of other kinds, such as those prescribed after food poisoning or an operation, are generally useless here — motion sickness needs drugs that act on the balance system itself.
Children on the road
Everything above applies to children too; the difficulty is getting them to agree. The peak age is roughly six to twelve; by adolescence most grow out of it, and parents are better off knowing that before they despair.
The hardest part is taking away the phone and the book, because those are exactly what set the nausea off, and a child on a long journey is bored. There are substitutes: audio stories, songs, conversation, spotting games out of the window — they occupy without forcing the eyes downward. Seat the child where the road ahead is visible, do not wrap them up too warmly, and open the window a crack. Feed them lightly and not sweetly before setting off, and on long drives stop more often than adults would need.
If a child is sick several times in a row, keep an eye on fluids: small sips of water, often. Dry lips and tongue, no urine for six to eight hours, and unusual drowsiness or listlessness are the warning signs, and they mean seeing a doctor the same day.
When the journey is not the problem
Motion sickness is always tied to movement: it begins during the journey and settles soon after it stops. If the pattern is different, so is the cause.
Call an ambulance straight away (in Spain, Italy, Portugal, Poland and Ukraine the single European number is 112) if any of these come on suddenly:
- severe dizziness together with double vision, slurred speech, or weakness or numbness in an arm and leg;
- being unable to stand or walk, or veering to one side;
- a sudden, extremely severe headache unlike any before;
- vomiting with a high temperature, dislike of light and pain on bending the head forwards.
One uncommon but dangerous situation is worth remembering separately: if everybody in the car starts feeling ill at once — nausea, headache, dullness — and everybody improves quickly in the open air, the cause may be carbon monoxide from a faulty exhaust or heater. In that case stop immediately, get out of the vehicle, air it out and get help, rather than putting it all down to travel sickness.
Without rushing, but without leaving it either, see a doctor if dizzy spells also happen at rest, if they come with noise in one ear or loss of hearing, if nausea and dizziness have appeared for the first time in adult life in somebody never previously affected, or if a child has repeated, identical bouts of vomiting lasting hours with no journey involved at all.
Online consultation
A doctor at the other end of a screen is useful here in two situations. The first is when a journey is coming up and last time was miserable: working out what is actually going on, choosing something appropriate given age, pregnancy, other medicines and whether you will be driving, and leaving you with a clear plan of what to take, when, and what to pack.
The second matters more. A good deal of what gets called travel sickness is nothing of the kind: the label covers attacks of vertigo, migraine with nausea, inner ear disease and even anxiety about flying. From the description — when it started, how long it lasts, what has happened to hearing and headaches, whether the same thing happens at home — a doctor can say whether this looks like ordinary motion sickness or whether it is time to investigate. The limits of the format are plain: examining you and testing balance and hearing cannot be done through a screen, and sudden severe dizziness with weakness, double vision or slurred speech calls for an ambulance rather than a call.
This material is for information only and does not replace medical advice.
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