Motion sickness

Also called Travel sickness, Seasickness, Car sickness

A mismatch between what the eyes see and what the balance organs feel. Prevention works far better than treatment once it has started.

What it is

Nausea and vomiting caused by conflicting signals between the inner ear, the eyes and the body's position sense.

It is very common, particularly in children between about two and twelve, and improves with age for most people. It is more common in women, in people who get migraine, and in pregnancy.

**Once nausea has started, treatment works poorly**, which is why almost everything useful is preventive and needs doing before travelling.

Non-drug measures genuinely work: sitting where motion is least, in the front of a car, over the wing of a plane, midship on a boat; looking at the horizon or a fixed distant point; keeping the head still against a headrest; fresh air; avoiding reading and screens; and eating something light rather than travelling on an empty or a very full stomach.

Medication is effective and must be taken in advance. Hyoscine works best but causes drowsiness and dry mouth and is not suitable for everybody. Antihistamines such as cinnarizine and promethazine are alternatives. Acupressure bands have limited evidence and are harmless.

Habituation is real: repeated exposure reduces sensitivity, which is why sailors adapt.

The important thing to exclude is that recurrent vomiting with dizziness is not something else: migraine, vertigo, Ménière's disease or, rarely, a posterior fossa tumour in a child.

Signs you might notice

Nausea and vomiting during travel.

Cold sweats, pallor, and increased saliva.

Dizziness, headache and fatigue.

Yawning and a general sense of unease before the nausea starts.

Settling within minutes to hours of the motion stopping.

Not motion sickness, and needing assessment: vomiting without motion; headaches with vomiting, particularly in the morning; unsteadiness that persists after travelling; hearing loss or tinnitus; double vision; or vomiting with weight loss.

In a child: persistent morning vomiting with headache needs assessment for raised pressure in the head. See brain tumours.

Urgent: severe dehydration from repeated vomiting, particularly in a small child.

How it can affect day-to-day life

Timing is everything with medication: hyoscine needs taking around 30 minutes before travel, and antihistamines one to two hours before. Taking them once the nausea has begun rarely helps, and this is the commonest reason people conclude they do not work.

Children get car sick most, and practical measures make the difference: a booster seat high enough to see out of the front window, no screens or books, a cool car, breaks on long journeys, and a window open.

Distraction with music or conversation works better than trying to sleep for some people, and sleeping works well for others.

Ginger has modest evidence and is harmless.

Anticipatory anxiety amplifies it, so a child who has vomited on every journey starts feeling sick before the car moves; addressing that directly helps.

For anyone who travels for work by sea or air, occupational advice and habituation training exists.

Recovery is quick once the motion stops, and fluids afterwards prevent the headache.

Supporting someone well

Take medication in advance: 30 minutes to two hours before travel, not once nausea starts.

Sit where the motion is least: front of the car, over the wing, midship.

Look at the horizon or a fixed distant point, and keep the head still.

No reading and no screens.

Fresh air, and a cool environment.

Eat something light beforehand; avoid an empty stomach and a heavy meal.

For children, raise the seat so they can see out of the front, and take regular breaks.

Address anticipatory anxiety, which makes it worse before the journey starts.

Get vomiting that happens without motion, or with headache or hearing change, properly assessed.

Where to get help

A pharmacist for over-the-counter medication and advice; they can advise on what suits children and pregnancy.

A GP practice for severe or persistent symptoms, or for prescription options.

A GP practice urgently for vomiting with headache in a child, or dizziness that persists after travel.

Migraine Trust where migraine is part of the picture.