Motion sickness

Purpose of review The public's longstanding resigned tolerance to motion sickness threatens to change, due to the widespread introduction of nauseogenic tilting trains and the increasing use of virtual reality immersion, Recent findings Scientific effort over the last 5 years has focused on precise evaluation of the stimuli that provoke sickness and on the development of behavioural and new pharmacological interventions to suppress sickness. Summary The precise mechanical ride characteristics of vehicles that provoke sickness have been identified and this will lead to guidelines for future engineering design, especially for suspension systems that compensate for inertial tilt, and recommendations for passengers at risk. The frequency characteristics of motion provoking sickness have been defined with greater precision and identified with shifts in perception of motion versus orientation, and changes in the quality of reflex eye movements. Ability to modify readily the time constant of vestibular 'velocity store' has emerged as a potential candidate marker of successful motion sickness habituation. Behavioural 'autogenic' countermeasures to the development of sickness, such as controlled breathing,,,which can be implemented readily, are shown to have significant ameliorating effects on nausea and are of value for short term moderate exposures. New classes of pharmacological agents such as N-methyl-D-aspartate antagonists and 5HT(1a) receptor agonists show promise in animals but await trials in humans.