General Travel Health

Preventing Motion Sickness.
-- Frank Gillingham, MD

Motion Sickness is remarkably common and while some people are more susceptible than others, there's probably no one who is immune if the motion stimulus is strong enough and unfamiliar enough. While modern cruise ships are designed with stabilizer systems to minimize the movements that stimulate Motion Sickness, in certain types of weather there's no ship design that can prevent seasickness.

Background
Motion Sickness appears to result when the brain receives conflicting information about body position and balance from the eyes, ears, joints and muscles, over a prolonged period of time. Children seem to be more easily affected than adults. Fortunately, the brain is remarkably adaptive and can eventually learn to anticipate the motion of a boat or vehicle, reducing the sensory conflict--a process sailors refer to as "getting your sea legs."

Motion Sickness is more than simple nausea and vomiting. While many patterns occur, yawning, drowsiness, and fatigue are often the first abnormal symptoms victims report. Some people notice stomach awareness, slight sweating, clammy skin, headache and a feeling of warmth. Motion Sickness can make it very difficult to concentrate, even when the victim isn't vomiting. If you're a passenger on a cruise ship with no responsibilities for guiding the boat, Motion Sickness may be a terrific inconvenience but probably not dangerous. However, if you have a job to do, as a crew member of a sail boat, for example, you must manage or prevent your symptoms aggressively.

Managing Motion Sickness
Cruise ship passengers who are susceptible to motion sickness should request a room close to the center of the ship to minimize back and forth motion.

The key is to recognize symptoms early and respond to them. If you're on a boat, stay on deck and close to the center of the ship where the ship's motion is minimized (on a plane the center of the cabin may be more stable than other sections; ask to be reseated). Get some fresh air if possible--e.g. open the car window. Face forward. Use a technique called "horizon viewing" in which you position yourself so that you have good, broad view of the horizon in your peripheral vision. Some travelers find night-time travel easier--others rely on dark glasses to reduce the amount of visual stimulation. Most people find the front seat of the car more comfortable than the back.

Avoid reading or other tasks that take your eye off the horizon and require focusing. Closing your eyes may be helpful. Remain as still as possible. If symptoms are severe lie flat and, if possible, take a break from moving--that is, stop the car, get out and walk around. The symptoms may go away and stay away, even after you resume your journey.

Be careful what and how much you eat--nausea from any other cause will lower your susceptibility to motion sickness.

Grab a motion sickness bag just in case. As bad as it is to use it, the alternative is far worse. In addition, medications that treat nausea and vomiting such as Phenergan (generic name promethazine) can be helpful for treating Motion Sickness once it has occurred.

Medications for Prevention
People who are prone to Motion Sickness or others who feel strongly about avoiding it should consider using a medication to prevent it. These agents work best when used before symptoms start. Many people who take them after they begin to get sick notice little improvement and conclude that the drugs don't work. Give them a second chance--but plan ahead. Here are a few choices:

• Transderm Scop which requires a prescription, is a patch containing a drug called scopalomine. The patch is worn behind the ear for as much as three days at a time (see www.transdermscop.com). and is very effective in many people, as long as it is started well in advance of travel--as much as 6 hours according to some authors. (Transderm Scop was unavailable for awhile, apparently due to drug delivery issues which have been resolved.) It cannot be used by children and must be used cautiously, or not at all, by the elderly, those who are pregnant, those with glaucoma, prostate enlargement, or other serious medical conditions. The most common side effects are dry mouth and drowsiness; more serious side effects such as disorientation occur but are rare. Talk it over with your doctor but this is a good medication to investigate if Motion Sickness is a real problem for you.
  
  
• Scopace is an oral form of scopalomine (also requiring a prescription) that avoids some of the problems of the patch. For one, it's easier to adjust the dose to your own body size and medication requirement. Typical dosage is 1-2 tablets taken an hour before travel, which lasts up to eight hours. All the same warnings and side effects are in effect as with the patch. Scopace can be hard to find--it is produced in the US by Hope Pharmaceuticals, Scottsdale, Arizona. Check out www.motionsickness.net for more information.
  
  
• Bonine and Dramamine II (generic name Meclizine) and the original Dramamine (generic name Dimenhydrinate) are commonly used over-the-counter medications. They are less convenient than Transderm Scop because they must be taken several times a day. The side effects are similar to those caused by Transderm Scop, as are the reasons you shouldn't take these drugs in the first place. If you have any medical issues, talk it over with your doctor before using these.
  
  
• Ginger, the traditional Chinese herbal remedy, has been shown in one very small study to be effective in preventing Motion Sickness. It's available in many forms (pills, gingerroot that's chewed, etc.). Side effects appear to be minimal and allergic reactions uncommon. However if you have gallstones, diabetes, heart problems, if you are pregnant or breast feeding, or if you take any medication on a chronic basis, you should consult with your doctor prior to using ginger. Everyone using herbal products regularly should consider consulting with a licensed healthcare professional who is familiar with the use of herbal medications. Unfortunately, there probably isn't enough Ginger in Ginger Ale to help.
  
  

Other Preventive Devices and Techniques

• Relief Band (www.reliefband.com) is a battery powered, electrical stimulation device worn around the wrist that, according to the manufacturer's website, has received FDA clearance for Motion Sickness (a prescription version of the device has apparently received similar clearance for pregnancy-induced nausea). The mechanism of action isn't well understood--of course the same can be said about many therapies. It cannot be used by patients with cardiac pacemakers.
  
  
• Sea Bands (check out www.sea-band.com). These are worn around the wrist like sweatbands. Their proponents claim they work through acupressure.
  
  
• Biofeedback and relaxation techniques can in theory be used to prevent Motion Sickness.