Dextroamphetamine
Dextroamphetamine may increase the effectiveness of scopolamine or antihistamines by counteracting the sedative side effects of these medications, but there are concerns that the combination could further impair decision-making and motivational behavior.[18]Zhang LL, Wang JQ, Qi RR, et al. Motion sickness: current knowledge and recent advance. CNS Neurosci Ther. 2016 Jan;22(1):15-24.
http://www.ncbi.nlm.nih.gov/pubmed/26452639?tool=bestpractice.com
Although this treatment regimen has been used as a motion sickness prophylactic in military and space programs, it is unlikely to be made available to the general traveling public until an effective analog, free from adverse effects, is developed.
5-HT1 agonists (triptans)
5-HT1 agonists (e.g., sumatriptan) are used for the treatment of migraine. The rationale for their use in treating motion sickness is that depletion of serotonin (5-HT) provokes migraine and enhances susceptibility to symptoms of motion sickness in people without migraine.[37]Drummond PD. Effect of tryptophan depletion on symptoms of motion sickness in migraineurs. Neurology. 2005;65:620-622.
http://www.ncbi.nlm.nih.gov/pubmed/16116130?tool=bestpractice.com
In addition, 5-HT1 agonists have been shown to be effective against motion sickness in animals.[46]Yates BJ, Miller AD, Lucot JB. Physiological basis and pharmacology of motion sickness: an update. Brain Res Bull. 1998;47:395-406.
http://www.ncbi.nlm.nih.gov/pubmed/10052567?tool=bestpractice.com
[84]Javid FA, Naylor RJ. The effect of serotonin and serotonin receptor antagonists on motion sickness in Suncus murinus. Pharmacol Biochem Behav. 2002;73:979-989.
http://www.ncbi.nlm.nih.gov/pubmed/12213545?tool=bestpractice.com
Rizatriptan has been shown to reduce susceptibility to motion sickness in people with migraine who have vertigo as a symptom (vertiginous migraine).[85]Marcus DA, Furman JM. Prevention of motion sickness with rizatriptan: a double-blind, placebo-controlled pilot study. Med Sci Monit. 2006;12:PI1-PI7.
http://www.ncbi.nlm.nih.gov/pubmed/16369474?tool=bestpractice.com
[86]Furman JM, Marcus DA, Balaban CD. Rizatriptan reduces vestibular-induced motion sickness in migraineurs. J Headache Pain. 2011 Feb;12(1):81-8.
https://www.doi.org/10.1007/s10194-010-0250-z
http://www.ncbi.nlm.nih.gov/pubmed/20862509?tool=bestpractice.com
Intranasal scopolamine
Intranasal scopolamine sprays offer an even faster route and, with higher (alkaline) pH buffered formulations to promote absorption, peak blood levels may be achieved in minutes.[87]Klocker N, Hanschke W, Toussaint S, et al. Scopolamine nasal spray in motion sickness: a randomised, controlled, and crossover study for the comparison of two scopolamine nasal sprays with oral dimenhydrinate and placebo. Eur J Pharm Sci. 2001;13:227-232.
http://www.ncbi.nlm.nih.gov/pubmed/11297908?tool=bestpractice.com
[88]Ahmed S, Sileno AP, de Meireles JC, et al. Effects of pH and dose on nasal absorption of scopolamine hydrobromide in human subjects. Pharm Res. 2000;17:974-977.
http://www.ncbi.nlm.nih.gov/pubmed/11028944?tool=bestpractice.com
One study has shown low-dose intranasal scopolamine reduced motion sickness induced by a rotating drum.[89]Simmons RG, Phillips JB, Lojewski RA, et al. The efficacy of low-dose intranasal scopolamine for motion sickness. Aviat Space Environ Med. 2010;81:405-412.
http://www.ncbi.nlm.nih.gov/pubmed/20377145?tool=bestpractice.com
However, another study found that while intranasal scopolamine was effective at reducing motion sickness, the time to maximal concentration was long compared with other intranasal drugs and previous studies of intranasal scopolamine.[90]Stankovic AS, Alvarenga DL, Coleman Daniels VR, et al. Intranasal scopolamine for motion sickness. Aerosp Med Hum Perform. 2019 Nov 1;90(11):917-24.
https://www.doi.org/10.3357/AMHP.5456.2019
http://www.ncbi.nlm.nih.gov/pubmed/31666152?tool=bestpractice.com
Acupressure
Stimulation of the pericardium 6 (P6) acupressure point by fingers, bracelets, or electrical stimulation can prevent the nausea and vomiting of motion sickness.[60]Streitberger K, Ezzo J, Schneider A. Acupuncture for nausea and vomiting: an update of clinical and experimental studies. Auton Neurosci. 2006;129:107-17.
http://www.ncbi.nlm.nih.gov/pubmed/16950659?tool=bestpractice.com
[61]Hu S, Stern RM, Koch KL. Electrical acustimulation relieves vection-induced motion sickness. Gastroenterology. 1992;102:1854-8.
http://www.ncbi.nlm.nih.gov/pubmed/1587405?tool=bestpractice.com
The P6 point is found between the tendons of the palmaris longus and flexor carpi radialis muscles, 3 patient finger breadths away from the flexor crease on the wrist.
Noninvasive brain stimulation
Modulating brain activity in the frontal and parietal regions, which are key components of the vestibular network, through transcranial alternating current stimulation or transcranial direct current stimulation, has shown promising results in reducing susceptibility to motion sickness.[91]Yang M, Li Z, Pan F, et al. Alpha tACS on parieto-occipital cortex mitigates motion sickness based on multiple physiological observation. IEEE Trans Neural Syst Rehabil Eng. 2024;32:2398-407.
https://ieeexplore.ieee.org/document/10578048
http://www.ncbi.nlm.nih.gov/pubmed/38949929?tool=bestpractice.com
[92]Li G, Zanto T. Reduced VR motion sickness by applying random-phase transcranial alternating current stimulation to the left parietal cortex. Brain Stimul. 2024 May-Jun;17(3):550-2.
https://www.brainstimjrnl.com/article/S1935-861X(24)00077-9/fulltext
[93]Takeuchi N, Mori T, Suzukamo Y, et al. Modulation of excitability in the temporoparietal junction relieves virtual reality sickness. Cyberpsychol Behav Soc Netw. 2018 Jun;21(6):381-7.
http://www.ncbi.nlm.nih.gov/pubmed/29792509?tool=bestpractice.com
[94]Arshad Q, Cerchiai N, Goga U, et al. Electrocortical therapy for motion sickness. Neurology. 2015 Oct 6;85(14):1257-9.
https://www.neurology.org/doi/10.1212/WNL.0000000000001989