This common form of physiological dizziness occurs in susceptible individuals usually with prolonged vestibular stimulation.
It may also be caused by visual stimulation. This may be induced by real or apparent motion. The condition is the result of the mismatch of information that is reaching the vestibular nuclei and cerebellum from the visual, labyrinthine, and somatosensory systems.
It is usually managed effectively by labyrinthine sedatives.
Complete bilateral vestibular loss makes the patient resistant to motion sickness.
Migraine and Motion Sickness
• Migraine patients are more prone to motion sickness
• Motion sickness in children may be the starting feature of migraine
Dizziness, fatigue, pallor, cold sweats, salivation, nausea, and vomiting develop when the person is aboard a ship, in a car, on an airplane, or in space.
Aggravating Factors (Visual Vestibular Conflict)
- Visual vestibular conflict occurs when the person is not able to visualize movement, viz. sitting in an enclosed cabin of a ship.
- Reading in a car and riding in the back seat of a car.
- Migraine patients are more prone to motion sickness.
Relieving Factors (Minimizing Visual Vestibular Mismatch)
- Standing on the deck of the ship and focusing on the horizon or land.
- Sitting in the front seat of a car and looking off in the distance.
- Minimizing head movements by resting the head against the headrest of a vehicle.
Treatment of MOTION SICKNESS —
1) Physical Measures
Repeated gradual exposure to motion produces protective habituation.
2) Antihistamines (Block H1 receptor in emetic center)
- Dimenhydrinate (Dramamine),
- Diphenhydramine (Benadryl), and
- Promethazine (Phenergan) though sedative are most effective.
- Meclizine and cyclizine are less sedative and less effective.
Oral administration is advisable an hour before motion exposure.
Injection or rectal suppository of promethazine is very effective once vomiting begins.
The following agents have little or no effect:
D2 receptor antagonists: Metoclopramide and domperidone
5HT3 receptor antagonists: Ondansetron.
4) Scopolamine (Acetylcholine Muscarinic Receptor Antagonist)
It is a good prophylactic agent, particularly for prolonged exposure at sea.
Transdermal preparation is applied to the mastoid region 4 hours before motion exposure. It releases the drug gradually for 72 hours.
5) Amphetamine and Ephedrine
Though effective their use is restricted because of addictive potential.
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