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On a road trip, there are many phrases that fill a driver with dread. "Are we nearly there yet?" ranks high, second only to "I've been sick."
It's estimated that around one in three people are considered highly susceptible to motion sickness, with children aged between seven and 12 being the most likely to suffer symptoms. Of course, this nausea isn't reserved for cars. Motion sickness can be triggered by aircraft, sea travel, computers (known as cyber-sickness) and even by riding a camel.
Yet, despite its prevalence, motion sickness is one of those few illnesses that’s still flooded with old wives' tales. As a child, you may remember being forced to sit on brown paper, or gnaw sickly ginger sweets that made your stomach turn more than the motion of the car itself.
The latest research from the University of Warwick suggests that the cure to this age-old dilemma might lie in doing a puzzle before you start a journey. The study used a driving simulator and passenger simulator to test motion sickness among volunteers. It found that, after completing daily brain exercises before travelling, reports of nausea among participants fell by more than half. Although it wasn’t clear why the tasks helped to reduce sickness, it suggested they may have improved the participants' sensory skills, therefore minimising their chances of motion sickness.
We’ve asked John Golding, a professor of psychology and car sickness expert from the University of Westminster, how we can separate fact from folklore.
Why do we get motion sick?
Car sickness is thought to be caused by what Prof Golding calls a "sensory mismatch". This is where the messages from the tiny balance organs in our inner ears, from our eyes and from our body don't match up, leading the brain to get confused. The mismatch triggers the symptoms of motion sickness.
"If I move my head to the left, the visual world should go to the right. If I jump up and down I might cause some short vibrations. On the whole, gravity always points down," says Prof Golding. "However, these things can be violated if you’re on a boat, or in a car."
Indeed, it widely depends on the type of motion, rather than the movement itself. Napoleon reportedly found that when he put his elite cavalry on camels in the Battle of the Nile, they started to feel nauseous. The same effect hasn't been observed in horse riding.
The main symptoms of motion sickness are nausea and vomiting. However, Prof Golding says that further symptoms can include, "sweating and facial pallor, stomach awareness, increased salivation, sensations of bodily warmth, dizziness, drowsiness, headache, increased sensitivity to odours, and loss of appetite."
Although it may seem like the most pointless of life’s inventions (up there with the appendix) motion sickness might be the triggering of an old evolutionary defence mechanism to protect us from toxins.
“Your balance system has receptors to detect toxins and poisons - just like in your brain, mouth and gut,” says Prof Golding. “If that goes out of alignment with conflict, or mismatch, then the brain starts to think it’s been poisoned, which it takes as a warning to be sick.”
How can you treat car sickness?
1. Positioning matters – fact
Your siblings didn't 'bagsy' the front seat for nothing. Figures from the RAC show that 75 per cent of present car sickness sufferers say that the back seat is where they experienced the most nausea. According to Prof Golding, sitting in the front seat can help to alleviate sickness.
“Sitting in the back seat is the worst because your field of view is restricted. If you can see a stable horizon, it can help your brain resolve the sensory conflict - you understand how you are moving, rather than what your brain thinks is happening.”
This ability of our brain to feel as if we're controlling the motion, and consequently predict it, is why the driver of a car rarely feels sick.
“Rally car drivers will usually have a co-driver, who will either be looking at a stopwatch, or a computer screen. Because they're bouncing around a lot, many co-drivers feel sick," says Prof Golding. "Even though drivers are also in extreme motion, they hardly ever get sick. If you reversed their roles, you would see the same pattern."
2. Breathing techniques can help – fact
There is evidence to show that controlled breathing - that’s taking deep yogic-style breaths - can help to ease car sickness symptoms.
In 2009, researchers from Imperial College London enlisted 26 volunteers to sit in a tilting, rocking flight simulator and coordinate their breathing in various ways with the motion. The tests lasted up to 30 minutes, or until subjects felt moderately sick. The natural tendency was for volunteers to inhale on every backward tilt, in rhythm with the rocking. But if the subjects exhaled on every backward tilt, they didn't get sick as quickly. They felt even better if they breathed slightly faster or slower than the cyclic heaving of the chair; using that technique, the researchers found that the time until onset of nausea was 50 per cent longer than during normal breathing.
Professor Golding puts this down to the “reflex between respiration and vomiting”, which is essentially in place to prevent us from choking on our own sick.
“If you’re breathing, that tends to inhibit the vomiting reflex. Equally if you’re vomiting, that inhibits you breathing if you don’t want to inhale your own vomit,” says Prof Golding. “If you can get good control of your breathing you can start to override feelings of nausea.”
It takes practice, though. If you are going to try this technique, Prof Golding recommends taking a quiet moment before your car trip to familiar yourself with the breathing pattern. When done correctly, controlled breathing has about half the efficacy of an anti-motion sickness drug - but with none of the unpleasant side effects, such as drowsiness.
3. Take ginger to prevent sickness – folklore
The evidence is mixed on this one. A study in the journal Lancet involved 36 people highly susceptible to motion sickness. The researchers had the subjects take either two capsules of powdered ginger, an anti-sickness medication or a placebo, and then, 20 minutes later, spin on a motorized chair for up to six minutes. Taking ginger delayed the onset of sickness about twice as long as taking the medication. The study also found that half the subjects who took ginger lasted the full six minutes, compared with none of those given the placebo or the medication.
Such studies are small though, and there still isn’t conclusive evidence that ginger can alleviate car sickness.
“There’s an active ingredient in ginger called gingerol which probably does tend to calm the gut – the evidence that it’s effective against motion sickness is limited,” says Prof Golding.
4. Taking regular car trips can minimise motion sickness – fact
It may sound unpleasant, but you can “habituate” yourself to car sickness through repeated exposure, says Prof Golding. Astronauts, fighter pilots and sailors have all been subjected to trials in rotating chairs that induce motion sickness. In a small study, a group of French researchers found that they could help seasick sailors using a series of visual exercises and sessions in a rotational chair. They improved the symptoms in 71 per cent of the people taking part – although it wasn’t a complete cure.
This acclimatization is part of the reason why car sickness tends to improve with age. According to Prof Golding, infants and very young children seem to be immune to motion sickness, with the onset of motion sickness susceptibility starting from around six to seven years of age and peaking around age nine. It then tends to improve into adulthood.
Don't expect your symptoms to be cured by a four-hour road trip, though. The best way to habituate is to take regular, short car trips before building up to longer ones.
5. Sitting on paper can stop you feeling carsick – folklore
Oh how simple car journeys would be if this solution was true! The myths range from sitting on an old (not current) newspaper to brown paper bags - and many people are convinced that they work. However, there are no clinical trials to prove this theory and any effect is likely only to be placebo, according to Prof Golding.
“If that really worked the problem will have been solved by now,” he added.
6. Pressure bands help ease sickness – fact/folklore
They're a common sight on school coach trips and ferries, but the jury's out on the science of pressure bands. They're designed to reduce nausea by stimulating the P6 Neiguan acupuncture point using a small white ball attached to the band. Supposedly, this then stimulates the median nerve, interrupting the “I’m sick” messages sent between the brain and the stomach.
"There's a great element of suggestion here - some studies say they work, and others say they don't. The placebo effect is probably quite large," says Prof Golding.
Acustimulation bracelets, which deliver small electric pulses to the median nerve, might prove more promising –although again the research is slim. One small study in the journal Military Medicine found that it prevented nausea among test subjects in a driving simulation. A review of 29 studies turned up mixed results on its ability to ease pregnancy-related nausea.
7. Medication works – fact
The pills and potions designed to alleviate car sickness do work – but only if they are taken effectively.
"There's no point taking medication once you already feel sick - well before you start to feel nauseous, your stomach stops absorbing things. It's a way of trying to protect you," he says.
While he says most motion sickness drugs, such as Kwells, can be taken half an hour to an hour before travel, others take longer to kick in. Stugeron, a common pill taken to ease travel sickness, can be quite slow to act and should be taken three hours beforehand. Meanwhile, the transferable patch – which can help to prevent travel sickness for up to 72 hours – can take between eight and ten hours to work. It works by releasing a medication called hyoscine hydrobromide into the skin. The hyoscine blocks receptors in the vomiting centre from receiving messages from the vestibular system (the part of the inner ear which controls balance). This prevents the "sensory mismatch" which causes the feelings of nausea.
It's also important to be aware of the side-effects, which can include drowsiness and blurred vision. If you know you're going to be driving later on, it's best to avoid taking anti-motion sickness medication all together.