Motion Sickness is another example of how evolution can’t keep up with technological advances like land, air, and sea travel.
Although we understand how it’s possible that we’re moving in a car or a bus, the older structures of the brain don’t. They’re responsible for managing all the processes that happen without us being in control, like digestion and pupil dilation.
These structures can’t adapt fast enough, and when there’s something they don’t understand, they react to let the conscious you know something’s wrong.
Some examples include a headache from jet lag, nausea from reading in a moving vehicle, or feeling sick after seeing something disgusting on a video.
I’ll shortly explain the physiology of motion sickness, who is most at risk, how to prevent it, and what treatments actually work.
In This Article
What is Motion Sickness?
Motion sickness is a syndrome of dizziness, nausea, vomiting, increased salivation, yawning, and malaise induced by motion.
It often begins subtly. A vague abdominal discomfort, sometimes described as “stomach awareness.” Then fatigue. Yawning. Reduced alertness. If the motion continues, pallor, cold sweating, nausea, and even vomiting may follow.
It’s important to note that it is not a disease but a physiologic (normal) response to specific motion.
The Physiology: Why Motion Makes You Sick
At its core, motion sickness is caused by sensory conflict.
Your brain constantly integrates signals from:
- The vestibular system (inner ear balance organs)
- The visual system (what you see)
- Proprioception (body position feedback)
When these signals don’t agree, the brain struggles to reconcile them. For example:
- Reading in a car → eyes say “still,” inner ear says “moving.”
- Below deck on a ship → body feels motion, eyes see a stable cabin.
This mismatch activates brainstem centers involved in nausea and vomiting. Anticholinergic, antihistaminic, and dopaminergic pathways are implicated.
Interestingly, medications that reduce symptoms may slow the brain’s natural adaptation process.
Most people adapt in 1-3 days. We don’t know the exact mechanisms, but it’s a combination of suppressing the inputs causing the conflict and recalibrating the brain’s models and predictions of motion.
The adaptation can be so strong that, after a very long sea voyage, “landsickness” can occur after a sudden stop in movement. Causing the same symptoms as motion sickness.
Common Symptoms of Motion Sickness
Motion sickness symptoms evolve in stages:
Early signs:
- Yawning
- Fatigue
- Reduced alertness (“sopite syndrome”)
- Mild malaise
Progression:
- Pallor
- Cold sweating
- Salivation
- Headache
Advanced symptoms:
- Nausea
- Vomiting
- Incapacitation
Additional features include thermoregulatory disruption, dizziness, vertigo-like sensations, ocular strain, and headache.
Who Is Most Susceptible?
Motion sickness affects the general population, but not equally.
Sex differences: Women are more susceptible, particularly during menstruation and pregnancy
Age: Rare under age 2. Susceptibility peaks between 12 and 15 years and declines with age. It is least common in the elderly.
History matters: A prior history strongly predicts recurrence.
Migraine and anxiety: Both increase risk, supported by vestibular research.
Cruise travel data: Up to 25% of passengers on large ships may develop symptoms within the first 2–3 days.
Motion Sickness by Travel Type
Motion Sickness in Cars
- Car sickness is common, especially in children.
- Low-frequency horizontal oscillations (turns on the road) are the main trigger.
- Reading or screen use increases sensory conflict.
- Sitting in the back seat raises risk.
Driving is protective because control and predictability reduce the mismatch.
Motion Sickness in Buses and Coaches
- Buses combine sustained motion with unpredictable turns.
- Stable visual references are often limited, and passengers cannot anticipate movement. That loss of control matters.
Motion Sickness on Trains
Rates are lower than for cars or buses. However, tilting trains can provoke symptoms due to complex acceleration patterns and vertical perception mismatch
Motion Sickness on Planes
- Large commercial aircraft are generally stable.
- Turbulence and small aircraft increase provocation.
- Seats located over the wings offer the most stability.
Seasickness and Cruise Travel
- Seasickness is driven by low-frequency vertical motion (heave).
- Smaller boats are more provocative due to pitch and roll.
- Most travelers on multiday cruises improve within 1–3 days through habituation.
- However, “landsickness” can occur after prolonged sea travel when motion suddenly stops.
Evidence-Based Non-Pharmacologic Prevention
Prevention is always easier than treatment — and with motion sickness, this is especially true.
Seat selection matters:
- Over airplane wings
- Center of the ship, lower deck, but above sea level
- Front seat of a car or bus
Visual orientation:
- Look at the horizon
- Avoid reading or screens
- Keep your head stable
- Close eyes if needed
Lifestyle strategies:
- Small, light meals
- Avoid alcohol
- Fresh air
- Controlled breathing
Habituation: Gradual exposure over 3–4 days reduces symptoms in most travelers
Ginger and Acupressure: Do They Work?
Ginger (about 1 g powdered) has a low risk but limited high-quality evidence.
Acupressure wristbands show inconsistent results. Some travelers swear by them.
Science remains mixed, but in lab conditions, it was shown they’re no more effective than a placebo. However, the placebo effect is real, and it can occur even when you know it’s a placebo.
Pharmacologic Prevention: What Works?
Medication works best when taken before motion exposure.
It blunts the central nervous system response to sensory conflict. That means adaptation may be delayed.
For cruise vacations, this is key. If symptoms are tolerable, limited medication use may allow faster habituation. For many travelers, short-term pharmacologic prevention during the first 1–2 days is sufficient.
- Antihistamines (H1 blockers)
These are the most commonly used drugs for motion sickness prevention. Typical side effect is drowsiness, which was historically countered by adding a stimulating compound. Nowadays, it’s rare due to potential abuse.
Examples: meclizine, dimenhydrinate, promethazine
Mechanism: Suppresses vestibular signaling.
Common side effects:
- Drowsiness
- Dry mouth
- Blurred vision
In children, paradoxical agitation can occur. Generally considered safe in pregnancy (Category B).
- Scopolamine (Antimuscarinic)
Often used as a transdermal patch. Effective for cruise travel and prolonged exposure. One patch can last 72 hours, but takes 6 to 12 hours to start working.
Side effects:
- Dry mouth
- Blurred vision
- Tachycardia
- Urinary retention
Avoid in:
- Glaucoma
- Prostatic hypertrophy
Can cause confusion or hallucinations in elderly patients.
- Ondansetron
May reduce vomiting.
However, it does not address core vestibular mismatch.
Not first-line for motion sickness prevention.
Treatment Once Symptoms Start
Immediate steps:
- Get fresh air (roll down the window, get on the deck of the ship)
- Look at the horizon/ distant point
- Stabilize the head
- Lie down with eyes closed
- Small sips of fluids.
- Avoid heavy meals and alcohol.
Be aware: once nausea begins, gastric stasis (delayed stomach emptying) may reduce the absorption of oral medications.
Summary: Smart Travelers Prepare
Motion sickness is common, predictable, and manageable.
It stems from sensory conflict between vision, vestibular input, and body perception. Symptoms range from mild fatigue to vomiting and incapacitation. Risk varies by age, sex, migraine history, and travel type.
The most effective strategy? Combine seat selection, visual stabilization, gradual exposure, and, when needed, evidence-based medication.
Don’t let preventable nausea steal your travel experience.
If you found this guide helpful, explore my other travel medicine resources and use these strategies on your next trip.
Resources
Travel Medicine, 4th Edition – December 13, 2018, Authors: Jay S. Keystone, Phyllis E. Kozarsky, Bradley A. Connor, Hans D. Nothdurft, Marc Mendelson, Karin Leder, Language: English, Hardback ISBN: 9780323546966
Centers for Disease Control and Prevention (CDC). (2023). CDC Yellow Book 2024: Health Information for International Travel. Oxford University Press.
Leung, A. K., & Hon, K. L. (2019). Motion sickness: An overview. Drugs in Context, 8, 2019-9-4. https://doi.org/10.7573/dic.2019-9-4
Cha, Y. H., Golding, J. F., Keshavarz, B., Furman, J., Kim, J. S., Lopez-Escamez, J. A., Magnusson, M., Yates, B. J., & Lawson, B. D. (2021). Motion sickness diagnostic criteria: Consensus Document of the Classification Committee of the Bárány Society. Journal of Vestibular Research, 31(5), 327. https://doi.org/10.3233/VES-200005
Koch, A., Cascorbi, I., Westhofen, M., Dafotakis, M., Klapa, S., & Kuhtz-Buschbeck, J. P. (2018). The Neurophysiology and Treatment of Motion Sickness. Deutsches ÄRzteblatt International, 115(41), 687. https://doi.org/10.3238/arztebl.2018.0687
Bertolini, G., & Straumann, D. (2016). Moving in a Moving World: A Review on Vestibular Motion Sickness. Frontiers in Neurology, 7, 175198. https://doi.org/10.3389/fneur.2016.00014
Disclaimer:
The information provided in this blog post is for general informational and educational purposes only and is not a substitute for professional medical advice. Always consult your physician or other qualified healthcare provider with any health problem. The use or reliance on any information provided in this blog post is solely at your own risk.
