Motion sickness is caused when the brain’s estimate of motion is different from what the person is actually experiencing. The person’s eyes, balance centre of the inner ear and general perception of their body’s position and movement conflict with the messages the brain receives. The sensitivity to motion sickness varies in individuals, but most people will experience it if the cause is strong enough. Pregnant women, children older than two years and those with migraines are most susceptible. First aid care is often ineffective, and providers should emphasise prevention instead.
Guidelines
- Eating a light meal or taking in ginger before travelling may help prevent motion sickness. *
- Controlled breathing and distracting the ill person with an activity (e.g. listening to music) may help to reduce symptoms of motion sickness. *
- Looking straight ahead through the windshield, looking outside and fixing the gaze on a central point on the horizon, as well as restricting one’s view may help to prevent motion sickness. Sitting in a chair with a high backrest, sitting facing in the direction of travel, wearing a P6 acupressure or P6 acustimulation wristband, and having control over the movement of the vehicle (driving oneself) may also help prevent motion sickness. *
Good practice points
- Stopping the means of transport may decrease nausea.
- Getting fresh air during travel – with a window open and air on the face – may reduce symptoms of motion sickness.
- Those that have used medications such as antihistamines to relieve motion sickness in the past should continue to use them if they are found to be effective.
Chain of survival behaviours
Prevent and prepare
There is some evidence to show the following ways for preventing motion sickness:
- Eat a light meal before travelling.
- Drive the vehicle yourself, if possible.
- Take 1 to 2 grams of ginger (e.g. tea or biscuits) before or during travel.
- Sit in a chair with a high backrest during travel and sit facing forward.
- Look outside and fix the gaze on a central point on the horizon.
- Wear a P6 acupressure or P6 acustimulation wristband while travelling.
Additionally, people might find it helpful to:
- Take mint or peppermint before or during travel.
- Some people find it easier to sleep through travel (unless driving oneself).
- Get fresh air during travel.
Early recognition
The person is travelling in conditions that induce motion sickness, such as a winding road or rough waves on the water.
- Initially, the person’s skin may become pale or ashen.
- The person may feel dizzy or have a headache.
- As symptoms progress, the person may experience nausea or vomiting.
First aid steps
- Stop travelling if possible, to allow the person time to recover and take corrective action.
- If it is not possible to stop travelling, tell the person to face forward and to look straight ahead at a fixed point on the horizon.
- If possible, provide fresh air and encourage the person to take slow and regular breaths.
- Try to distract the person, (e.g., play some music).
Access help
Usually, motion sickness passes without the need to access help.
Education considerations
Context considerations
- Include the types of transport and related first aid care that are relevant to learners and their environment.
- Some areas may have safety considerations that prevent learners from stopping their vehicle. The first aid education should acknowledge and discuss these considerations in a learning activity.
Learner considerations
- People who travel with children (teachers, parents, coach drivers) may find it useful to learn about motion sickness.
Facilitation tips
- Focus on prevention in this topic as first aid is limited in its effectiveness and people may react differently to the various preventative suggestions.
- Ask the learners for their experience of motion sickness as this will help to establish relevant context.
- Inform learners that people who take certain medications (e.g., antidepressants, asthma medications and even ibuprofen) may be more susceptible to motion sickness. Also inform them that some medications (e.g., antihistamine) may make the person drowsy and diminish the reflexes needed for safe driving.
Scientific foundation
Systematic reviews
The Centre for Evidence-Based Practice (CEBaP) developed evidence summaries on the use of controlled breathing and travel activities for motion sickness, as well as on several preventative interventions.
First aid care
Controlled breathing
There is limited evidence from three randomised controlled trials in favour of controlled breathing. Evidence showed that controlled breathing resulted in a statistically significant increase in time to moderate nausea and a decrease in the mean symptoms of motion sickness, compared to spontaneous breathing. Evidence is of very low certainty and results cannot be considered precise due to limited sample size.
Activities
There is limited evidence from one randomised controlled trial in favour of listening to music, and from one non-randomised controlled trial in favour of distraction. The randomised controlled trial study showed that listening to music resulted in a statistically significant increase in time to moderate nausea in people experiencing mild nausea due to motion sickness. The non-randomised controlled trial showed that distraction resulted in a statistically significant decrease of subjective misery (measuring nausea, vomiting, dizziness, headache, (cold) sweat and stomach awareness). When looking at counting compared to not counting to treat motion sickness, two randomised controlled trials could not demonstrate a statistically significant decrease in motion sickness symptoms. In three experimental studies, it was shown that reading or watching a video resulted in a statistically significant increase in motion sickness perception. All evidence is of very low certainty and results cannot be considered precise due to limited sample size, lack of data and large variability of results.
Prevention
View
There is limited evidence in favour of:
- Looking outside: three studies showed that looking outside resulted in a statistically significant decrease in symptoms, compared to looking at the inside environment. However, this could not be shown in a fourth study. Similarly, one study showed that looking at the horizon resulted in a statistically significant decrease in motion sickness compared to not looking outside. However, this decrease could not be demonstrated when comparing looking at the horizon to looking outside. Finally, in one study, it was shown that keeping the eyes open resulted in a statistically significant decrease in motion sickness, compared with keeping the eyes closed.
- Performing a task on a high-mounted tablet: in one non-randomised controlled trial, people were asked to sit down in the passenger seat of a car and perform a task on a tablet that was either mounted at eye-height (high visual display, offering considerable peripheral out-the-window views) or onto the glove compartment (low visual display). The high visual display resulted in a statistically significant decrease in symptoms, compared to the low visual display.
- Restricting one’s field of vision or fixating on a central point: when compared to an unobstructed view, no fixation point or inside view only, restricting the field of vision or fixating on a central point resulted in a statistically significant decrease in mean illness rating and subjective symptoms of motion sickness and nausea, based on six studies.
In addition, a statistically significant decrease in mean illness rating when looking inside or outside, compared to wearing a blindfold, or when having an unobstructed view compared to a narrowed forward view, could not be demonstrated by three studies. All evidence is of very low certainty, and results are imprecise due to limited sample size and lack of data.
Seating
There is limited evidence in favour of using a high backrest and sitting in a forward orientation, from one experimental study each. One study showed that sitting with a high backrest resulted in a statistically significant decrease in mean illness rating, compared to a low backrest. Another study showed that forward orientation resulted in a statistically significant decrease in motion sickness, compared to backward orientation.
Additionally, there is limited evidence neither in favour of sitting in the middle rear seat nor sitting behind the driver. Results from one study could not demonstrate a statistically significant decrease in mean illness rating when seated in the central rear seat compared to sitting directly behind the driver. Furthermore, there was no demonstration of a statistically significant decrease in mean illness rating when seated in the first row of a multi-purpose vehicle, compared to sitting in the second row. All evidence is of very low certainty, and results are imprecise due to limited sample size and lack of data.
Driving oneself
There is limited evidence from three experimental studies in favour of driving oneself. One study showed that having control over the vehicle’s movement resulted in a statistically significant decrease in motion sickness symptoms and mean well-being score, compared to having no control. It also showed that being or moving as if you were the driver (i.e. actively tilting your head instead of passively following the motion, thereby imitating the driver), resulted in a statistically significant decrease in total symptom score, compared to being a passenger or moving as if you were a passenger. Evidence is of low certainty and results are imprecise due to limited sample size.
Eating and drinking
There is limited evidence from four experimental studies in favour of eating before travelling. One study showed that eating a zero-fat meal resulted in a statistically significant decrease in nausea, compared to eating a high-fat meal. A second study showed that compared to eating an entirely carbohydrate-based meal, or no meal at all, having a high-protein meal resulted in a statistically significant decrease in the subjective symptoms of motion sickness.
A third study compared eating breakfast to going without it while a fourth compared eating either a high protein and low carbohydrate meal or a low protein and high carbohydrate meal to just drinking water. In both cases, the intervention resulted in a statistically significant decrease in the symptoms of motion sickness. However, a statistically significant decrease in the symptoms of motion sickness when comparing an entirely carbohydrate-based meal, or a meal with both moderate carbohydrate and protein portions, to no meal or drinking water only, could not be demonstrated.
There is limited evidence from one experimental study in favour of taking ginger before travelling. Results showed that 1000 or 2000 mg dose of ginger had a statistically significant decrease in nausea during and after the illusion of the body in motion, compared to a placebo.
There is limited evidence from one experimental study neither in favour of drinking water or milk, nor nothing at all. When comparing drinking milk or water to not drinking anything, a statistically significant decrease in subjective symptoms of motion sickness could not be demonstrated.
All evidence is of very low certainty and results of this study are imprecise due to the limited sample size and lack of data.
Wrist bands
There is limited evidence from seven experimental studies in favour of wearing P6 acupressure or P6 acustimulation wristbands. When analysing this evidence, we placed a higher value on the outcome of subjective symptoms of motion sickness over peak total symptoms score or nausea (as it is one of the many symptoms of motion sickness). Studies showed that P6 acupressure or P6 stimulation resulted in a statistically significant decrease in subjective symptoms, compared to the control, dummy point acupressure or a placebo. Another study showed that P6 acupressure had a statistically significant increase in time to moderate nausea, compared to the control. When comparing the use of P6 acupressure or P6 acustimulation to a placebo, the evidence did not demonstrate a statistically significant decrease in symptom severity, peak total symptoms score, subjective symptoms or nausea. Evidence is of very low certainty and results are imprecise due to limited sample size, lack of data and large variability of results.
References
Systematic reviews
Centre for Evidence-Based Practice, Belgian Red Cross-Flanders. (2020). Evidence summary Motion sickness – Travel activities. Available from: https://www.cebap.org/knowledge-dissemination/first-aid-evidence-summaries/
Centre for Evidence-Based Practice, Belgian Red Cross-Flanders. (2020). Evidence summary Motion sickness – Seating position. Available from: https://www.cebap.org/knowledge-dissemination/first-aid-evidence-summaries/
Centre for Evidence-Based Practice, Belgian Red Cross-Flanders. (2020). Evidence summary Motion sickness – Eating or drinking. Available from: https://www.cebap.org/knowledge-dissemination/first-aid-evidence-summaries/
Centre for Evidence-Based Practice, Belgian Red Cross-Flanders. (2020). Evidence summary Motion sickness – Wristbands. Available from:
https://www.cebap.org/knowledge-dissemination/first-aid-evidence-summaries/
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