Motion Sickness: Systems Out of Sync

By Sarabeth Lowe, MPH

Ms. Lowe is a Communication Specialist at the University of Delaware Disaster Research Center.

Whether you’re riding in a car, flying on a plane, cruising on a boat, or floating through outer space, motion sickness can affect you. Kinetosis, the clinical term for the condition, is common and temporary, but nonetheless can make any type of travel a dreaded affair.^1–9 Here’s what you need to know.

Causes of motion sickness: Systems out of sync

Despite how common it is, experts have not yet established the exact mechanism behind motion sickness.^{6–8,10–12} The most widely accepted theory is grounded in the sensory conflict and neural mismatch model, which describes 3 bodily systems becoming out of sync as a result of real (ie, physical) or virtual (ie, perceived) motion.^11–13 In simple terms, our brains like to know and be able to anticipate what’s going on around us.^{2,3,5,7,8,10–12,14–17} If our brain can’t work out why our body is moving, this creates some internal confusion that disrupts the body’s normal routine.

There are 3 key systems involved in motion sickness:

Visual system (our eyes): This system is how we see the world around us. It sends the inputs it receives to the visual centers of our brain.^12,18–21 Our eyes constantly perform automatic micromovements as we move through space. This response is called the vestibulo-ocular reflex (VOR).^21–24 When you turn your head or experience any kind of motion, the VOR makes your eyes move in the opposite direction so that our visual field stays steady. This constant reflex helps maintain our gaze and stay balanced.

Vestibular system (balance and motion): Our eyes are connected to our vestibular system, the sensory organs that allow your body to understand how you’re moving and how things around you are moving; it’s the system that helps maintain your balance or steadiness.^{7,12,21,25–27} In the case of motion sickness, the peripheral part of this system, which includes balance organs in your inner ear, is involved. Experts theorize that this system has the greatest influence on developing motion sickness.¹²

Proprioceptive system (the “sixth sense”): Proprioception is the automatic or subconscious process that signals to your brain where your limbs are without relying on visual input.^{7,12,16,28–30} For example, this is how your body adjusts the muscle tension in your feet and legs to maintain your balance and walk smoothly on an uneven surface. This awareness comes from multiple receptors around our body.

When processing sensory information, the brain constantly monitors and stimulates these systems and specific reflex behaviors so we can function and perform everyday tasks. The efficiency of this anatomical integration is based on experience and outcome.^{2,5,7,8,11,12,31} It works well because our bodies have evolved so that these 3 systems—visual, vestibular, and proprioceptive—work in concert without any sensory conflict.

The downside of this process is that our bodies are unprepared and ill-equipped for things with which it has no experience.^{4,12,16,26,27} Humans have not evolved as a species to drive on twisting roads, float through space, or experience virtual reality.^12,26

With motion sickness, the vestibular system and our visual inputs are in conflict because they’re detecting different sensations. This can happen with real and perceived motion. A common example of this is focusing on a stationary object, like a phone or book, when riding in a car. The same can be said for someone wearing a virtual reality headset or watching an immersive 3D movie without moving. The body doesn’t know how to anticipate, manage, or de-escalate this neural mismatch.^2,12,32 This releases a cascade of hormones and neurotransmitters that trigger symptoms of motion sickness—stomach awareness, nausea and vomiting, dizziness, low blood pressure, increased salivation, cold sweats, and pale, clammy skin.^{2–4,6,7,10,15,16,33,34}

Motion Sickness Triggers

Not all movement causes motion sickness. Research shows that low-frequency motion, which can be described as slow, sweeping, and rhythmic, typically triggers it. Movement can come from any direction; it can be vertical (up and down), lateral (side to side), reciprocating (forward and backward), and rotational (spinning).^{8,9,11,13,26,27,35,36} This explains why seasickness—where large, undulating waves cause slow, deep movement—is more common than air sickness, where the motion is generally smoother and steadier.^16,19,31,34 The more pronounced the motion, the more likely symptoms will manifest. This theory also explains why active, anticipated movement, like pedaling on a bike to propel yourself forward or riding a horse, usually doesn’t cause motion sickness.¹²

Similarly, not all people are equally susceptible to it. Research shows that women tend to experience motion sickness more than men. This discrepancy may be due to hormonal fluctuations, such as those during pregnancy or certain stages of the menstrual cycle, that may increase susceptibility.^{10–12,36–39} Certain health conditions, such as vertigo and migraines, can make people more likely to experience motion sickness.^26,27,36 Age also plays a role. Infants and young children typically do not experience motion sickness, but older children (especially those between 6 and 12 years of age) do. This upward trend levels off as people age into adulthood, as they learn the typical relationships between the body’s different senses and are able to contextualize their experiences.^{2,11,12,21,26,27,34,36,38,40,41}

Treatment and Prevention Options

Motion sickness is much easier to prevent than treat, and sometimes prevention isn’t possible. For the most part, symptoms will not cease until the movement stops.^{10,12,26,27,31,34,42,43} Most of the nonpharmacologic methods for easing motion sickness are behavioral, such as getting fresh air and taking deep breaths, or involve reducing or distracting from conflicting sensory input.^{9,12,15,27,31,34,38} The latter includes strategies such as sucking on hard candy or wearing acupressure bands. Though many of the products for managing motion sickness have mixed results on their physiological impact, research shows that the placebo effect can be a significant factor in treatment and prevention.^{10,27,31,34,42,44–48} 

Unfortunately, most drugs developed for motion sickness have significant side effects, such as drowsiness, and are only partially effective.^{2,10,12,31,49} Many experts concede that habituation is the most effective way to reduce motion sickness.^{2,4,7,15,16,27,31,34,35,43,45,50} However, this kind of desensitization isn’t always feasible because it can take weeks to achieve, is often stimulus-specific, and requires consistent re-exposure to maintain.

Dos and Don’ts—Managing Motion Sickness

While you can’t fully prevent motion sickness, there are several tools and strategies that can help reduce the symptoms.

DO find the right spot. Avoid sitting in areas where there is a lot of motion, such as the bow of a ship, near the wings on a plane, or the back seat of a bus. Try to face forward when possible. This will help align the incoming visual and inner-ear vestibular information, boost your VOR, and reduce sensory conflict.²⁶

DON’T resist motion. Some research shows that aligning your body with the gravitational pull can lessen motion’s nauseating effect. An example of this is leaning into the sideways pull of a turn by tilting your head when riding on a curvy road or “wave riding” on a boat.^14,51–54 

DO stare at the horizon. Try to keep your head still and focus your eyes on the horizon or a fixed, stationary object. This can help suppress the development of symptoms by enhancing your VOR.^32,55 

DON’T focus inward while in motion. Avoid reading or using your phone while in motion. Intensely focusing on a stationary object while at speed amplifies the sensory conflict that leads to motion sickness.

DO eat wisely. Don’t eat any large meals or rich foods before traveling. If you’re hungry, try to have small snacks. There are mixed findings on whether eating can mitigate motion sickness, but most experts agree that either end of the spectrum—having an empty stomach or feeling overly full—will increase the likelihood of developing symptoms.^2,3,12,56,57

DON’T overhydrate or consume alcohol. Aim to take sips of water throughout your trip. Avoid caffeinated or alcoholic beverages before and while traveling. Consider putting a hold on that can of ginger ale; research has shown that ginger does not significantly suppress motion sickness, though more research is needed to definitively establish a causal relationship between them.^58,59

DO discuss treatment options. While there is no cure for preventing or treating motion sickness, there are a variety of avenues for trying to manage it. How well a strategy works depends on your body and the type of travel. Thanks to the placebo effect, alternative methods, such as wearing fluid-filled motion sickness glasses or deep breathing, might feel just as effective as mainstream medication. Interventions are likely to be most effective if the person believes that they will work.^{11,12,14,34,48,54}

DON’T delay taking medication. Medication is most effective when taken before traveling, rather than after the onset of symptoms. There are 3 main types of drugs for motion sickness, and all have side effects and/or potential medical contraindications.^{2,12,14,27,33,49,54} Be sure to do your research before choosing a medication and to test it before traveling. 

DO prepare properly. If you’re prone to motion sickness, there are a few ways to prepare. Explore what tools or strategies could be helpful. This might mean bringing a pair of headphones to distract yourself, grabbing some mints for your purse, or choosing your seat ahead of time. For the most severe cases of motion sickness, cognitive behavioral therapy has been shown to be effective in preventing motion sickness.^54,60–62

DON’T travel alone. Part of preparing for your trip is choosing your companions. If you’re prone to motion sickness, inform whoever is traveling with you ahead of time and tell them about any symptoms as early as possible. Even if they can’t stop motion sickness in its tracks, they can help make the trip more comfortable, safer, and less stressful in practical ways, such as letting you drive or encouraging travel breaks, or by providing distraction or moral support if you become ill.

Bottom Line

Motion sickness might be one of the most common health conditions, and most people experience a bout of it during their lives. The symptoms can be overwhelming and debilitating, turning any journey into a harrowing slog. Despite motion sickness being one of the most universal afflictions, research has yet to firmly establish the mechanisms behind it or a cure. Understanding its potential causes and triggers, however, can help you strategize ways to manage potential episodes and symptoms. With motion sickness, a little preparation can go a long way in making your travels more comfortable, so you can spend less time counting down to the minutes to reaching your destination and more time enjoying the journey.

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