Abstract
Motion sickness affects at least one third of the population, varying in degree of individual sensitivity and severity. Sensory mismatch between vestibular, visual and proprioceptive inputs with the cognitive visuospatial map is the primary theory for its occurrence. Whilst stimulus avoidance and medication are common treatment, neurovestibular habituation is often overlooked as therapy in civilian patients.
A 55-year-old woman presented with her two adult children with a life-long history of severe motion sickness. Significant anticipatory anxiety accompanied with nausea would begin prior to boarding, triggered by the smell of airline food and jet fuel. In flight, dizziness and severe recurrent vomiting would occur, often leading to incapacitation and pre-syncope. Specialist investigation found no underlying vestibular or neurological disorder. A multi-agent pharmaceutical approach with neurovestibular habituation exercises allowed the patient to undertake a multi-stage international airline travel without significant illness. Her daughter reported similar improvement on medication alone. Following a break in habituation exercises and without the medication, the symptoms reoccurred on a future flight.
Motion sickness is often treated as a vestibular condition in isolation without consideration of the neuropsychological aspects. Conditioning to environmental cues including smells along anticipatory anxiety may trigger symptoms of motion sickness in absence of motion cues. Multi-agent pharmaceutical therapy may be more effective than single agents alone. Neurovestibular habituation exercises are low cost but effective means of producing tolerance of motion cues with symptom reduction. This can be sustained with ongoing environmental exposure.