Motion sickness
Background
- Motion sickness occurs in the setting of passive motion or with a visual stimulus, which is perceived as actual movement (virtual reality).
- It is possible to induce motion sickness in nearly all adults with enough provocation.
- Individuals are more susceptible to motion sickness, depending on the risk factors below.
Risk Factors
Patient Factors
- Women
- Ages 2-12 years old (peaks at 12 y/o)
- Hormonal: Pregnant, menstruating, oral contraceptives
- Other sensory Illness: Altered visual or vestibular sensory cues (labrynthitis)
- Migraine disorder
- Psychosocial
Environmental Factors
- Type of motion: The greater the magnitude of low frequency horizontal or vertical motion the greater the motion sickness
- Body position: Supine position alleviates motion sickness
Clinical Features
- Dizziness
- Nausea
- Increased salivation
- General malaise
- Diaphoresis
Differential Diagnosis
- Benign positional paroxysmal vertigo
- Meniere Disease
- Vestibular Neuronitis
- Labrynthitits
- Cerebrovascular Event
Evaluation
- Evaluation is clinical and based upon the patient's history.
- Metabolic Panel to determine dehydration or electrolyte abnormalities f patient has been vomiting.
- CT scan of head If concerned for stroke/hemorrhage; depending on patient's risk factors, hx reveals a recent fall and patient is taking blood thinners.
Management
- Antihistamines (Diphenydramine, chlorpheniramine, cyclizine, meclizine)
- Anticholinergics (Scopalamine)
- Antidopaminergics (Promethazine, metoclopramide)
- Sympathomimetics (Ephedrine, amphetamines, caffeine)
- Benzodiazepines
- Anti-emetics (prochlorperazine, odansetron)
- GABA agonists (baclofen, gabapentin)
Disposition
- Discharge if motion sickness is the primary diagnosis
- Educate patient on motion sickness and their susceptibility based on their risk factors. Inform the patient on how to prevent motion sickness with body position and medications. Encourage patient to return to ED if symptoms worsen.