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 yo)
  • 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 paroxysmal positional vertigo
• Meniere Disease
• Vestibular neuritis
• Labyrinthitis
• Cerebrovascular event

Evaluation

• Evaluation is clinical and based upon the patient's history.
• BMP to evaluate dehydration/electrolyte abnormalities if significant amount of vomiting
• CT head (if concern for stroke/hemorrhage)

Management

• Antihistamines (Diphenhydramine, chlorpheniramine, cyclizine, meclizine)
• Anticholinergics (Scopolamine)
• Antidopaminergics (Promethazine, metoclopramide)
• Sympathomimetics (Ephedrine, amphetamines, caffeine)
• Benzodiazepines
• Antiemetics (prochlorperazine, ondansetron)
• 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.

See Also

• Vertigo