Airsickness: Symptoms, Types, Causes and Treatment

Airsickness, commonly known as "motion sickness" when experienced in flight, remains a significant challenge for both passengers and aircrew. Despite technological advances in aviation, the human body’s response to the unique stimuli of flight—especially during turbulence or aerial maneuvers—can result in a range of distressing symptoms. Understanding airsickness is crucial for anyone who spends time in the air, from occasional travelers to professional pilots. In this article, we explore the symptoms, types, causes, and treatments of airsickness, drawing on the latest research and real-world experience from aviation medicine.

Symptoms of Airsickness

Airsickness manifests in a variety of physical and psychological symptoms, often making the flying experience uncomfortable or even debilitating. Recognizing these symptoms early can help individuals and flight crews take timely action to minimize their impact.

Symptom	Description	Frequency/Significance	Source(s)
Nausea	Feeling sick or urge to vomit	Most common symptom	125
Vomiting	Actual expulsion of stomach contents	Moderate incidence	125
Pallor	Pale complexion	Frequently observed	2
Cold Sweating	Sweating without heat	Common	2
Malaise	General feeling of discomfort	Often reported	2
Tremors	Involuntary muscle shaking	Associated with severe cases	1
Face Flushing	Reddening of the face	Linked to anxiety	1
Anxiety	Heightened nervousness	Correlated with severity	1
Nightmares	Disturbed sleep patterns	Predicted higher risk	1
Urinary Frequency	Increased urination	Noted in some cases	1

Table 1: Key Symptoms of Airsickness

Common Physical Symptoms

The most frequently reported symptoms of airsickness include nausea and vomiting. These symptoms may be accompanied by pallor (a sudden loss of skin color), cold sweating, and a sensation of general malaise or discomfort. Other notable physical signs are tremors and face flushing, particularly in those who are more severely affected 12.

Psychological and Secondary Symptoms

Airsickness doesn't just affect the body—it can also impact the mind. Anxiety, excessive nervousness, and even nightmares have been observed as both predictors and results of airsickness, especially among trainee pilots or those with a history of motion sensitivity. Increased urinary frequency has also been noted, possibly as a stress response 1.

Symptom Progression and Impact

The intensity of symptoms can range from mild discomfort to severe, incapacitating illness. For some, symptoms abate after acclimatization, while others may develop a cycle of anxiety and worsening sickness if not addressed early 12. Recognizing the pattern of symptoms is essential for timely intervention and effective management.

Types of Airsickness

While airsickness is often lumped together under the broader term "motion sickness," it actually encompasses several distinct types, each with its own triggers and characteristics. Understanding these types helps in tailoring prevention and treatment strategies.

Type	Trigger/Description	Population Affected	Source(s)
Classic	Motion/turbulence in flight	Passengers, aircrew	2
Training-Related	Flight maneuvers, new stimuli	Student/trainee pilots	267
Chronic	Persistent, recurring symptoms	Select aircrew	346
Secondary	Psychological factors/anxiety	High-anxiety individuals	12

Table 2: Types of Airsickness

Classic Airsickness

Classic airsickness is the most common form, triggered by the motion and turbulence experienced during flight. It affects both passengers and crew, though the incidence has decreased among commercial passengers due to improved aircraft stability 2.

Training-Related Airsickness

This type predominantly affects student pilots or individuals exposed to new and unfamiliar flight maneuvers. The high rate among trainees is thought to be due to the combination of novel motion stimuli and psychological stressors inherent to flight training 267.

Chronic Airsickness

Some individuals, particularly aircrew, may experience chronic airsickness—persistent symptoms that recur with each flight, often leading to grounding and requiring specialized intervention 346.

Secondary or Psychogenic Airsickness

A subset of airsickness cases arises primarily from psychological factors such as heightened anxiety, stress, or even anticipation of symptoms. This form may overlap with other types but is marked by a strong emotional or cognitive component 12.

Causes of Airsickness

The underlying causes of airsickness are rooted in a complex interplay between the body’s sensory systems and psychological state. By understanding these mechanisms, we can better predict who might be at risk and how to prevent or mitigate symptoms.

Cause	Mechanism/Explanation	Risk Factors/Correlates	Source(s)
Sensory Conflict	Discordant input from eyes, inner ear, and body	Rapid motion, turbulence	2
Psychological	Anxiety and stress heighten symptoms	High anxiety, nightmares	12
Physical	Pre-existing health issues	Fatigue, illness	1
Environmental	Aircraft type and flight conditions	Unstable/turbulent flights	25

Table 3: Causes of Airsickness

Sensory Conflict Theory

The most widely accepted explanation for airsickness is the sensory conflict theory. During flight, especially in turbulent or unusual maneuvering conditions, the signals received by the eyes, inner ear (vestibular system), and body do not match. This discord confuses the brain, resulting in classic airsickness symptoms 2.

Psychological Contributors

Anxiety, stress, and even anticipation of sickness can predispose individuals to airsickness or worsen their symptoms. Research among student pilots has shown a moderate correlation between preflight anxiety and the likelihood of developing airsickness 1. Nightmares and persistent nervousness are also predictive 1.

Physical and Environmental Factors

Pre-existing health issues—such as fatigue or illness—can lower one’s threshold for airsickness. Environmental conditions, such as turbulent flights, rapid altitude changes, or flying in smaller, less stable aircraft, can also increase risk 25.

Who Is at Greatest Risk?

• Student pilots and trainees due to unfamiliar situations and maneuvers 267
• Individuals with high baseline anxiety or specific psychological vulnerabilities 1
• Passengers or crew subjected to turbulent or unstable flight conditions 5

Treatment of Airsickness

Airsickness is highly treatable, with approaches ranging from behavioral interventions to medications and technological aids. The choice of treatment depends on severity, frequency, and individual needs.

Treatment	Mechanism/Approach	Effectiveness/Notes	Source(s)
Biofeedback	Autonomic control/relaxation	High success in aircrew	3467
Desensitization	Gradual exposure to flight stimuli	77-79% success in pilots	67
Medication	Promethazine + caffeine, meclizine, scopolamine	Promethazine + caffeine most effective	5
Acustimulation	Wristband stimulation	Less effective	5
Counseling	Addressing anxiety/stress	Useful as adjunct	12

Table 4: Airsickness Treatments

Biofeedback and Behavioral Approaches

Biofeedback therapy trains individuals to recognize and control their physiological responses to motion stress. Patients learn relaxation techniques and practice autonomic control while being exposed to motion stimuli. Studies in military aircrew show that 77-79% of participants can return to full flying duties after such programs 3467. This approach is especially valuable for chronic or severe cases.

Desensitization Therapy

Desensitization involves gradual, structured exposure to motion stimuli, sometimes combined with biofeedback. Programs in Canada, the UK, and the US Air Force have demonstrated success rates of around 77%, allowing most affected pilots to resume flying 67.

Pharmacological Treatments

Several medications are used to manage airsickness:

• Promethazine + Caffeine: This combination has shown to be the most effective, significantly reducing nausea and motion sickness severity while maintaining alertness and performance 5.
• Meclizine and Scopolamine: Common over-the-counter or prescription options, but with variable effectiveness and potential side effects 5.
• Acustimulation Wristbands: Marketed for motion sickness, but generally less effective than medication 5.

Psychological Support and Counseling

Addressing underlying anxiety, stress, or anticipatory fear can be a crucial part of an overall treatment plan. Counseling and stress management techniques may help reduce susceptibility to airsickness, particularly in individuals identified as high risk 12.

Practical Tips for Prevention

• Choose seats over the wings, where motion is minimized
• Keep the head still and look out the window at the horizon
• Stay hydrated and avoid heavy meals before flying
• Use medications or behavioral techniques proactively if you know you are susceptible

Conclusion

Airsickness is a multifaceted condition influenced by physical, psychological, and environmental factors. Its symptoms can range from mild discomfort to severe incapacitation, especially among aircrew and trainees. Fortunately, modern research and treatment options provide relief and enable most individuals to continue flying.

Key Takeaways:

• Symptoms: Include nausea, vomiting, pallor, cold sweating, malaise, tremors, and anxiety 12.
• Types: Range from classic in passengers to chronic in aircrew, with special risk for trainees 23467.
• Causes: Stem from sensory conflict, psychological factors, and environmental conditions 125.
• Treatment: Encompasses biofeedback, desensitization, effective medication combinations (notably promethazine + caffeine), and psychological support 34567.

By understanding the mechanisms and available interventions, individuals and organizations can better prevent and manage airsickness, ensuring safer and more comfortable flights for all.