Motion Sickness by Dr. Rajiv Narula
Motion sickness is a common problem encountered by travelers – whether by sea, air land, camel or elephant ! We all suffer from it, the difference lies in the level of discomfort- 5% suffer heavily, 5% suffer minimally and the remainder 90 % suffer moderately. According to the Medical College of Wisconsin from one third to one half of airline passengers experience some degree of motion sickness when encountering heavy turbulence.
The body has two pathways whereby it maintains balance, one is visually and the other is maintained by the inner ear. Both inputs are relayed to the brain. If the brain is sent conflicting messages, which is what occurs, when for example, one is below deck on a ship. Visually your eyes see very little motion, because one is unable to see the horizon , however the inner ear senses the motion. Both these in turn send the brain conflicting messages which results in symptoms of motion sickness.
Symptoms vary from person to person, these generally consist of malaise, cold sweating, abdominal discomfort, nausea and vomiting. Other symptoms may include drowsiness, salivation, hyperventilation, headache and flushing. There is also a major psychological component ; some persons develop some of these symptoms in anticipation of an air flight or a boat ride. Most people will adapt rapidly to motion, that is they will be able to tolerate the motion that made them sick at the beginning of their voyage. The French term for the debilitating effect of motion illness is Mal de Mar, luckily it is not life threatening, although the person suffering sure feels like they are in a bottomless pit. Women are usually more susceptible than men, this is worsened near menstruation and pregnancy. Factors that can predispose one to feel motion sickness include – alcohol, certain drugs, and as stated earlier, anxiety levels and sleep deprivation. An interesting study published in Aviation Space Environmental Medicine in 1993 showed that Chinese subjects were more susceptible than Caucasians.
There are many remedies that are used, ranging from use of behavior therapy – avoiding rooms without a view of the horizon, to eating ginger , to using wrist bands and also the use of prescription medications in oral as well as in trans-dermal forms. Yet others believe in avoidance of certain foods prior to and during the trip.
The first scientific study regarding the use of ginger was published in 1982. In this study 940 mg of ginger were shown to be more effective than Dramamine 100 mg. However other studies have shown it not to be effective in certain situations. Issues that remain to be looked at include the quality of the ginger preparation and the time that is required for it to produce it’s effect. The most common prescription medication is probably scopolamine, it comes in two forms an oral preparation and a trans-dermal format. The ‘transderm patch’ is applied behind one’s ear, 6-8 hours prior to departure. Medication is released in a fixed dosage, it penetrates the skin and is then absorbed. Absorption differs between different persons and unfortunately in some cases may be too much, the amount released differs from person to person. On the other hand the oral formulation can be taken an hour before travel, and is effective for 8 hours. The dose can be titrated to the person’s weight and individual needs. It would be advisable to try the oral preparation prior to the patch. Both these can have the side effect of causing some drowsiness, use of alcohol with them must be avoided. Alcohol is perhaps the last thing on a person’s mind when they have that dreaded feeling of mal de mar !