• 
• 

Three Part Question

Does [ginger] prevent or reduce [the severity of motion sickness] in [young adults]?

Clinical Scenario

A 28-year-old woman experiencing dizziness, vertigo, nausea, and vomiting after riding a boat is brought to the emergency department. She has no systemic disease or diarrhea and denies being pregnant; her vital signs are normal. Her symptoms improve a lot after resting. She enquires about methods to prevent the motion sickness. You wonder whether natural ginger extracts could help prevent or reduce severity of motion sickness.

Search Strategy

Medline 1948 to August 2011
Cochrane Library
CINAHL
Medline 1948 to August 2011: (motion sickness.mp. OR exp Motion Sickness OR seasickness.mp.) AND (ginger.mp. OR exp Ginger OR Zingiber.mp.)
Cochrane Library: ginger AND motion sickness
CINAHL: ginger AND motion sickness

Search Outcome

Medline: Twenty-five papers were found, 6 of which were original research articles and were considered to be related to our topic of interest. An additional paper was mentioned in a review article. No additional relevant articles were found in the Cochrane Library. Thus, we were able to find a total of 7 papers that discussed the use of ginger for preventing or treating experimental and clinical motion sickness. (Table 1).

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Mowrey et al 1982 USA	36 volunteers (age, 18–20 years) with high susceptibility to motion sickness took ginger root capsule, dimenhydrinate, or placebo 20–25 min before sitting in a rotatory chair.	Randomized controlled trial	Durable time in the rotatory chair (seconds)	Placebo:90.0 ± 12.2;Ginger (940 mg): 335.8 ± 8.2 (p < 0.001);Dimenhydrinate (100 mg): 216.2 ± 10.0 (p < 0.001)	Small number of participants Suboptimal randomization
Wood et al 1988 USA	8 volunteers (age, 18–35 years) were given fresh ginger, ginger, dimenhydrinate, promethazine, scopolamine, d-amphetamine (in this sequence) 120 min before sitting in a rotatory chair.	Quasi-experimental study	Number of head movements required to achieve a score of 16 points on the Graybiel scale of motion sickness symptoms	Placebo：baseline for comparison;Fresh ginger (1000 mg): +1 (p = N.S.);Ginger (500 mg):-8 (p = N.S.);Ginger (1000 mg):-4 (p = N.S.);Ginger (500 mg):-8 (p = N.S.);Dimenhydrinate (50 mg):+79 (p < 0.05);Promethazine (25 mg):+81 (p < 0.05);Scopolamine (0.6 mg):+81 (p < 0.05);Scopolamine (1 mg): +183 (p < 0.05);d-Amphetamine (1 mg):+118 (p < 0.05)	Small number of participants Not a randomized controlled trial Volunteers would develop tolerance under repeated stimuli
Holtmann et al 1989 Germany	38 candidates (age, 22–34 years) took ginger root capsule, dimenhydrinate, or placebo (decided randomly) 90 min before sitting in a rotatory chair.	Quasi-experimental study	Post-rotatory response intensity	Baseline:6.71 ± 1.85;Placebo:6.65 ± 1.96;Ginger (1000 mg):6.81 ± 2.33 (p < 0.05);Dimenhydrinate (100 mg):5.50 ± 2.22 (p < 0.05)	Small number of participants no clinical outcomes, not a randomized controlled trial, and volunteers would develop tolerance under repeated stimuli.
Stewart et al 1991 USA	28 volunteers (age, 18–40 years) participated in the experimental protocol. 8 volunteers took ginger root capsule, scopolamine, or placebo (on separate days); other 8 volunteers took fresh ginger an hour before sitting in a rotatory chair.	Quasi-experimental study	Number of head movements required to achieve a score of 16 points on the Graybiel scale of motion sickness symptoms	Placebo:baseline for comparison;Ginger (500 mg):-8.8 ± 30.4 (p = N.S.);Ginger (1000 mg):-3.1 ± 16.5 (p = N.S.);Fresh ginger (1000 mg):-0.4 ± 11.5 (p = N.S.);Scopolamine (0.6 mg): 147.5 ± 22.1 (p < 0.01)	Small number of participants Not a randomized controlled trial Volunteers would develop tolerance under repeated stimuli
Lien et al 2002 Taiwan	18 volunteers (age, 18–40 years) with a history of motion sickness took ginger root capsule or placebo 60 min before sitting in a rotatory chair.	Quasi-experimental study	Nausea score(0–3; no nausea to severe nausea)	Placebo:2.5 ± 0.2;Ginger (1000 mg):1.7 ± 0.3 (p < 0.05);Ginger (2000 mg):1.8 ± 0.2 (p < 0.05)	Small numbers of participants Unclear randomization
			Durable time in the rotator chair (minutes)	Placebo:5.6 ± 0.6;Ginger (1000 mg):8.5 ±1.1 (p < 0.05);Ginger (2000 mg):9.7 ±1.1 (p < 0.05)
Grontved et al 1988 Denmark	80 healthy naval cadets (age, 16–19 years) who were not accustomed to the high seas took ginger root capsule (1000 mg) or placebo when at heavy seas during cruise.	Randomized clinical trial	Incidence of motion sickness(%)	Ginger: 60% (24/40) ;Placebo: 61.5% (24/39)	Small numbers of participants No power calculation Unclear randomization
			Score sum of all symptom categories reported at 4th hour(Nausea: 0–3 ;Vertigo: 0–3;Vomiting: 0–2;Cold sweating: 0–1)	Placebo:35;Ginger (1000 mg):18 (p < 0.05)
Schmid et al 1994 Norway	1741 tourist volunteers (age, 16–65 years) took ginger root capsule, dimenhydrinate/caffeine, or domperidone/cinnarizine 2 hr prior to the boat’s departure and were instructed on when to take the second dose, if required.	Randomized clinical trial	Degree of seasickness (none, slight, moderate, severe malaise, or vomiting)	Ginger root (500 mg); 2 doses:None: 78.3% (p = N.S.);Slight/moderate: 12.3% (p = N.S.);Severe/vomiting: 9.4% (p = N.S.);Vomiting: 7.9% (p = N.S.);Dimenhydrinate (50 mg)/Caffeine (50 mg); 1 dose:None: 81.4% (p = N.S.);Slight/moderate: 10.8% (p = N.S.);Severe/vomiting: 7.8% (p = N.S.);Vomiting: 4.1% (p = N.S.);Cinnarizine (20 mg)/Domperidone (15 mg); 2 doses:None: 77.7% (p = N.S.);Slight/moderate: 16.6% (p = N.S.);Severe/vomiting: 5.7% (p = N.S.);Vomiting: 4.8% (p = N.S.)	Unclear blinding method Did not have intention-to-treat analysis

Comment(s)

Motion sickness is an unpleasant sensation. Currently available anti-motion sickness medication may induce antimuscarinic and antihistamine effects such as dry mouth, lethargy, and drowsiness. Ginger root, a traditional herb, may be used as an alternative remedy for motion sickness. Although the mechanism by which motion sickness is prevented is unknown, studies show that ginger root probably acts on the gastrointestinal system rather than the central nervous system, which means that ginger does not have sedative effects. The findings of this short review of the literature show that ginger root capsules have mixed effects in preventing motion sickness under experimental conditions. Studies on clinical motion sickness show that ginger has the tendency to reduce the severity of motion sickness or is as effective as other anti-motion sickness medications. No significant adverse effects of ginger have been reported. However, properly conducted randomized clinical trials are needed to study clinical motion sickness.

Clinical Bottom Line

Ginger root capsules could be useful in preventing motion sickness, more so, if there are concerns about the sedative effects of traditional anti-motion sickness medication.

Level of Evidence

Level 3 - Small numbers of small studies or great heterogeneity or very different population.

References

1. Mowrey DB, Clayson DE. Motion sickness, ginger, and psychophysics. Lancet 1982;20:655–7.
2. Wood CD, Manno JE, Wood MJ, et al. Comparison of efficacy of ginger with various antimotion sickness drugs. Clin Res Pr Drug Regul Aff. 1988;6:129–36.
3. Holtmann S, Clarke AH, Scherer H, et al. The anti-motion sickness mechanism of ginger: A comparative study with placebo and dimenhydrinate. Acta Otolaryngol 1989;108:168–74
4. Stewart JJ, Wood MJ, Wood CD, et al. Effects of ginger on motion sickness susceptibility and gastric function. Pharmacology 1991;42:111–20.
5. Lien HC, Sun WM, Chen YH, et al. Effects of ginger on motion sickness and gastric slow-wave dysrhythmias induced by circular vection. Am J Physiol Gastrointest Liver Physiol 2003;284:481–9.
6. Grøntved A, Brask T, Kambskard J, et al. Ginger root against seasickness: A controlled trial on the open sea. Acta Otolaryngol 1988;105:45–9.
7. Schmid R, Schick T, Steffen R, et al. Comparison of seven commonly used agents for prophylaxis of seasickness. J Travel Med. 1994;1:203–206.