**Background:** Motion sickness (MS) is characterized by unpleasant symptoms—dizziness, headache, nausea, vomiting, cold sweating, and pallor—that occur during real transportation (car, ship, plane, train) or in virtual environments (simulators, VR, video games). It arises from sensory conflict between visual, vestibular, and proprioceptive inputs. Two categories exist: transportation sickness (real MS) and visually induced motion sickness (VIMS). A survey of 4,479 participants found 59% had experienced MS. The vestibular system is essential for MS, as patients with vestibular impairment are less susceptible. Current pharmacological treatments include antihistamines (dimenhydrinate, cyclizine, meclizine, promethazine, cinnarizine, betahistine), antimuscarinics (scopolamine), sympathomimetics (dextroamphetamine), and corticosteroids (dexamethasone). All have significant side effects including drowsiness, dry mouth, blurred vision, dizziness, and cognitive impairment. This review aims to comprehensively evaluate pharmaceutical, behavioral, and nutritional interventions for MS prevention and mitigation.
**Methods:** This is a narrative review of the literature on MS interventions. The authors synthesized findings from multiple studies examining pharmacological agents (with protection indices and side effect profiles), nutritional interventions (macronutrients, vitamins, plant-based compounds), and behavioral countermeasures (music, diaphragmatic breathing, odor, fresh air, autogenic-feedback training, habituation). Studies included human clinical trials, animal models, and observational reports across real and virtual environments.
**Key Results:** Pharmacological protection indices include: promethazine 78%, scopolamine 78%, dimenhydrinate 72.91%, cyclizine 71.24%, and meclizine 67.98%. Betahistine showed weak or uncertain effects. For nutritional interventions: vitamin C (500 mg) reduced seasickness incidence to 34% vs. 65.07% in placebo. Ginger (1-2 g) showed mixed results—some studies found reduced nausea and prolonged onset time, while others found no significant effect. The herbal formulation Tianxiang (1.82 and 3.64 g/kg) reduced histamine and acetylcholine in vestibular nuclei more effectively than scopolamine (1 mg/kg) in rats. Hesperidin (80 mg/kg) and dimenhydrinate (20 mg/kg) both significantly reduced MS in mice with no significant difference between them. High-fat meals increased MS symptoms; protein-enriched meals (53% protein) reduced symptoms compared to carbohydrate-enriched meals. For behavioral interventions: diaphragmatic breathing at 6 breaths/minute increased parasympathetic activation and reduced VIMS symptoms. Listening to favorite music significantly reduced MS symptoms compared to no-music controls. Fresh airflow decreased VIMS nausea and oculomotor symptoms. Autogenic-feedback training (AFT) increased MS onset time 2-3 times more than promethazine. Habituation programs showed >85% success rate but are time-consuming.
**Clinical Implications:** Non-pharmacological interventions offer viable alternatives to medications for MS management, particularly for populations where drug side effects are problematic (e.g., pilots, astronauts, frequent travelers). Nutritional strategies—particularly vitamin C, ginger, hesperidin, and protein-enriched low-fat meals—can reduce MS severity. Behavioral techniques activating the parasympathetic nervous system (diaphragmatic breathing, favorite music, fresh air) provide safe, affordable, and convenient mitigation. The combination of multiple approaches may be most effective. Key research gaps include: limited clinical trials on complementary treatments, insufficient investigation of taste/food texture effects on MS, need for balanced datasets accounting for age and gender differences, and underutilization of artificial intelligence (machine learning and deep learning) for MS detection and prediction. Future research should explore combined interventions, vestibular impairment effects on VIMS, and AI-based automated MS detection systems with uncertainty quantification.