Almost everybody is susceptible to motion sickness given the right (or wrong) conditions.

It seems intuitive to say that a person who suffers motion sickness on the sea or in a vehicle will be more likely to get motion sickness on an aircraft. However, this is not the case.

Motion sickness caused by one mode of travel does not predict motion sickness caused by another mode of travel.

How Common is Motion Sickness in pilots?

I remember clearly my first flight in a light aircraft which was a trial introductory flight with the aim of embarking on PPL training. I experienced significant motion sickness. My instructor said after the flight that motion sickness is common in new pilots and would probably settle down. I was a little sceptical to be honest. However, he was right – the motion sickness rapidly went away – and didn’t come back.

Another example is the budding sailor who gets severe motion sickness and staggers off a yacht after 4 days of initial training – only to never get motion sickness again.

Research has shown that around a third of student pilots experience motion sickness.

The good news is that research also demonstrates that motion sickness in student pilots usually settles down. The bottom line for student pilots is this – persevere and the problem will likely go away for reasons that will be explained.

Motion sickness in passengers is common in light to medium sized aircraft. This goes without saying though motion sickness is by no means universal.

What are the risk factors for motion sickness?

These are the following hunan risk factors for experiencing motion sickness:

  • Individual Variation – this is the most important factor! It’s not known know why some people are prone to severe motion sickness  and others are not
  • Female (twice the rate of males)
  • Age 3 to 12
  • Anxiety – though it’s a chicken and egg situation in that motion sickness in a light aircraft will make someone anxious

What Causes Motion Sickness?

Motion sickness usually settles down with repeated exposure to the same mode of travel. The reason is that the brain (in a neurological way)  “remembers” the previous neural mismatches (episodes of motion sickness or vertigo) so that future episodes of neural mismatch are compared with past experiences..

Incidentally, the fact that motion sickness tends to settle with repeated exposure forms the basis of one of the treatments that is used in military flying: Desensitisation – which means just that. The pilot is subjected to increasing intensities of stimuli (The Corolis effect) that provoke motion sickness in the Centrifugal Chamber. There may be further training in the simulator

Why Does Motion Sickness tend to settle with time?

Motion sickness usually settles down with repeated exposure to the same mode of travel. The reason is that the brain (in a neurological way)  “remembers” the previous neural mismatches (episodes of motion sickness or vertigo) so that future episodes of neural mismatch are compared with past experiences.

Incidentally, the fact that motion sickness tends to settle with repeated exposure forms the basis of one of the treatments that is used in military flying: Desensitisation – which means just that. The pilot is subjected to increasing intensities of stimuli (The Corolis effect) that provoke motion sickness in the Centrifugal Chamber.

The author experienced severe nausea during his first trial flight – and never experienced it again after >300 hrs.

Combatting motion sickness: Tips & Treatment

What can help before the flight?

  • Avoid food or drink that may cause nausea eg alcohol, spicy foods.
  • Be well rested
  • Have enough fluids

What should someone feeling the effects of motion sickness do?

It’s important to state that there is no single best way to act. There is quite a lot of individual variation.
Some of the things that can be tried (in order of what works best – literature, professional & personal experience are:
  • Keep the eyes focused on the distant horizon¹ ². This is easier for pilots than passengers :-)
  • Keep the head as still as possible.
  • Avoid talking about motion sickness! Maintain a positive attitude³. At least in the early stages this can be helpful.
  • Pilots are already focusing on flying the plane. However, situational awareness requires ‘relaxed concentration’ which in itself may reduce symptoms of motion sickness.
  • Good ventilation is helpful.
  • Passengers may listen to music or practice mindfulness.
  • Keeping the eyes closed can work for some passengers.

What are the treatments for motion sickness?

A passenger may consider with medical or pharmacist advice:
  • Kwells® (Hyoscine Bromide tablet – available over the counter as 0.3mg tablets). Usual dose for adults is 0.6mg taken an hour before travel. The tablet lasts around 6 hours. Side effects include drowsiness and dry mouth but sometimes dizziness or visual disturbance. Hyoscine is also available as a 24 hour patch (scopolamine) though this is not available in Australia.
  • Promethazine – better known as Phenergan® or Avomine®. Sedation more likely than with kwells.
  • Pseudoephedrine – best known as the decongestant Sudafed®, is also a stimulant that reduces the drowsiness caused by Hyoscine. The combination of Hyoscine and Pseudoephedrine is a traditional combination well known to coastguards.

Ondansetron is widely prescribed by doctors for nausea and vomiting caused by chemotherapy, gastroenteritis, and pregnancy. Research into Ondansetron and motion sickness have been disappointing. However, the medication may reduce nausea.

None of these treatments are recommended for pilots because of sedative and other side effects.
Kwells® has been researched in detail (Cochrane review of 14 randomized trials) and is probably the best one to start with.³ Take it to prevent as well as treat motion sickness, starting 1 hour before travel.³
Dr Richard Beatty, specialist GP & Designated Aviation Medical Examiner; BM FRACGP MRCP(UK) ACCAM
Last Reviewed / Modified: 20/9/2019
First Published: 5/12/2014
References
1: Golding JF. Motion sickness susceptibility. Auton Neurosci.2006;129(1-2):67-76
2: Griffin MJ, Newman MM. Visual field effects on motion  sickness in cars. Aviat Space Environ Med. 2004; 75(9):739-748.
3: ANDREW BRAINARD, MD, MPH, and CHIP GRESHAM, MD, Middlemore Hospital, Auckland, New Zealand; Prevention and treatment of motion sickness. AFP 1st July 2014.