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Why Do I Feel Dizzy After A Cruise

Published: January 4, 2024

by Meaghan Saad

Introduction

Have you ever experienced a bout of dizziness after a cruise? If so, you’re not alone. Many people report feeling lightheaded, unsteady, or dizzy after spending time on a cruise ship. While it may seem surprising, there are actually several reasons why this can occur.

Understanding the causes of post-cruise dizziness can help you prepare for your next voyage and take steps to mitigate any discomfort. In this article, we’ll delve into the factors that contribute to this sensation and explore remedies to alleviate it.

Motion sickness is a common condition that affects individuals of all ages and can lead to dizziness. It occurs when there is a disconnect between the movement your body feels and what your eyes see. When you’re on a cruise ship, your body is constantly adjusting to the rolling and rocking motions of the vessel. The constant movement can confuse your senses, causing dizziness and related symptoms.

One of the main culprits behind post-cruise dizziness is your vestibular system. This intricate network of structures and nerves in your inner ear is responsible for detecting motion, maintaining balance, and controlling eye movements. When the movement on a cruise ship triggers your vestibular system, it can result in feelings of dizziness and disorientation.

Another factor that contributes to dizziness after a cruise is the changes in sensory input experienced onboard. Your body relies on visual cues, such as a stable horizon, to maintain balance. However, on a ship, the visual environment is constantly moving. This conflicting sensory information can lead to a sensation commonly known as seasickness, which includes symptoms like dizziness, nausea, and vomiting.

Seasickness medication is often recommended to prevent or reduce the symptoms of motion sickness. While these medications can be effective for many people, they can also have side effects that contribute to dizziness. Some common side effects include drowsiness, dry mouth, and blurred vision. If you experience dizziness after taking seasickness medication, it may be worth exploring other options or adjusting the dosage.

Dehydration can also play a role in post-cruise dizziness. Spending time on a cruise ship, particularly in warm climates, can lead to increased fluid loss through sweating. When your body doesn’t have enough fluids, it can cause your blood pressure to drop, leading to dizziness. It’s important to stay hydrated during your cruise by drinking plenty of water throughout the day.

Anxiety and stress can exacerbate the sensations of dizziness after a cruise. The anticipation or fear of feeling unsteady can trigger an anxiety response in some individuals. Additionally, the unfamiliar surroundings, crowds, and new experiences that come with cruising can also contribute to feelings of stress. Managing anxiety through relaxation techniques, such as deep breathing or mindfulness exercises, can help alleviate dizziness.

In the following sections, we’ll explore remedies and strategies to combat post-cruise dizziness. By understanding the underlying causes and taking preventative measures, you can ensure a smooth and enjoyable cruising experience without the unpleasant feeling of dizziness.

Understanding Motion Sickness

Motion sickness is a common phenomenon that affects many individuals when exposed to certain types of movement. It is also referred to as seasickness, car sickness, or air sickness, depending on the mode of transportation. The symptoms of motion sickness can include dizziness, nausea, vomiting, and general discomfort.

The underlying cause of motion sickness lies in the intricate workings of our sensory system. When our body senses movement, various messages are sent to the brain through different channels: the eyes, the inner ear, and the sensory receptors in the muscles and joints. Normally, these messages are in sync and accurately convey our body’s position and movement in space.

However, in the case of motion sickness, there is a conflict between what our eyes perceive and what our other sensory systems detect. For example, when you’re on a ship, your eyes may see still surroundings, while your inner ear, responsible for detecting motion, senses the rocking and swaying of the vessel. This mismatch in sensory information results in confusion and can lead to symptoms of motion sickness, including dizziness.

It’s important to note that not everyone is equally susceptible to motion sickness. Some individuals have a higher tolerance for motion, while others may be more prone to experiencing symptoms. Factors such as age, previous history of motion sickness, and individual differences in sensory processing can influence the likelihood and severity of symptoms.

Motion sickness can be particularly common on cruise ships due to their constant motion on the water. The rolling and pitching of the ship, combined with the absence of a stable visual reference point, can make it more challenging for the body to adapt and maintain balance. This can lead to increased feelings of dizziness and discomfort.

While motion sickness can be unpleasant, the good news is that it is usually temporary and subsides once the motion stops. However, for individuals who frequently experience motion sickness, taking preventive measures can help reduce the severity of symptoms. This can include staying in areas of the ship with less motion, focusing on a stable object like the horizon, or using over-the-counter remedies like antihistamines or wristbands.

By understanding the mechanisms behind motion sickness, individuals can better prepare themselves to cope with the sensations and reduce the impact it has on their cruising experience. Whether it’s taking preventive measures or seeking medical advice, there are various strategies that can be employed to minimize the effects of motion sickness and subsequent dizziness.

Causes of Dizziness after a Cruise

Experiencing dizziness after a cruise is a common occurrence for many people. While it may seem puzzling at first, there are several factors that can contribute to this sensation. Understanding these causes can help you navigate through post-cruise dizziness and find ways to alleviate it.

One of the main causes of dizziness after a cruise is the constant motion and changes in equilibrium experienced onboard. When you’re on a cruise ship, your body is constantly adjusting to the rolling and swaying motions caused by the waves. This continuous movement can disrupt the sense of balance and coordination, leading to feelings of dizziness.

The vestibular system, located in the inner ear, plays a crucial role in maintaining balance and spatial orientation. The motion of the ship can stimulate and challenge this system, resulting in sensations of dizziness and disorientation. The constant motion onboard can create conflicting signals between what your vestibular system detects and what your eyes perceive, leading to a disconnect that can trigger dizziness.

In addition to the impact on the vestibular system, the visual environment on a cruise ship can also contribute to dizziness. Normally, your brain relies on visual cues to maintain balance and spatial orientation. However, on a ship, the visual environment is constantly moving, with the horizon shifting and objects appearing to sway. This visual mismatch can further confuse the brain and intensify feelings of dizziness.

Seasickness medication, such as antihistamines or scopolamine patches, are commonly used to prevent or alleviate the symptoms of motion sickness. While they can be effective for many individuals, these medications can also have side effects that contribute to dizziness. Some people may experience drowsiness or grogginess as a result of taking these medications, which can exacerbate feelings of lightheadedness.

Dehydration is another potential cause of dizziness after a cruise. Spending time on a ship, particularly in warm climates, can lead to increased fluid loss through sweating. When your body becomes dehydrated, it can affect your blood pressure and lead to dizziness. It’s important to stay hydrated by drinking plenty of water throughout your cruise to mitigate this risk.

Anxiety and stress can also play a role in post-cruise dizziness. The anticipation or fear of feeling unsteady can trigger anxiety or even panic attacks in some individuals. The unfamiliar surroundings, crowded spaces, and new experiences that come with cruising can also contribute to elevated stress levels. These psychological factors can amplify the perception of dizziness and create a cycle of heightened anxiety.

While it’s natural to experience some degree of dizziness after a cruise, there are steps you can take to alleviate these symptoms. In the next sections, we’ll explore remedies and strategies to help mitigate post-cruise dizziness and improve your overall cruising experience.

Vestibular System and Inner Ear

The vestibular system, located in the inner ear, is a complex and intricate network of structures and nerves that plays a crucial role in maintaining balance, spatial orientation, and coordinating eye movements. It is responsible for detecting motion, gravity, and head position, allowing us to navigate the world with a strong sense of equilibrium.

Within the vestibular system, there are three semicircular canals and two otolith organs. The semicircular canals are filled with fluid and aligned in different planes, detecting rotational movements of the head. The otolith organs consist of the utricle and saccule, and they detect linear acceleration and changes in head position, such as tilting and bending forward or backward.

When it comes to dizziness after a cruise, the vestibular system and the inner ear are key players. The rocking and swaying motion of a cruise ship can stimulate and challenge the vestibular system, sometimes overwhelming its normal functioning. This can lead to sensations of dizziness, unsteadiness, and disorientation.

The inner ear, specifically the vestibular apparatus, communicates with the brain to signal changes in motion and head position. When you’re on a cruise ship, the continuous movements can create conflicting signals between what the inner ear detects and what your eyes perceive. This sensorial mismatch can confuse the brain and manifest as dizziness.

In addition to detecting motion, the vestibular system also contributes to the maintenance of balance by coordinating eye movements. It works in conjunction with visual information from the eyes and proprioceptive feedback from the muscles and joints. On a cruise ship, where the visual environment is in constant motion, this coordination can be disrupted. The eyes may not provide a stable reference point, further contributing to feelings of dizziness and unsteadiness.

Individuals with pre-existing vestibular disorders or those who are more sensitive to motion may experience more severe dizziness after a cruise. In such cases, the challenges posed to the vestibular system may be more profound, resulting in heightened symptoms. It’s important to note that for most individuals, these symptoms are temporary and will resolve once the body adjusts back to stable ground.

Understanding the role of the vestibular system and inner ear in maintaining balance and detecting motion helps explain why dizziness can occur after a cruise. By being aware of these mechanisms, individuals can take appropriate measures to alleviate symptoms and adjust their environment to reduce the impact on their vestibular system. In the next sections, we’ll explore specific remedies and strategies to address post-cruise dizziness and promote a smoother transition back to solid ground.

Changes in Sensory Input on a Cruise Ship

One of the reasons why people can feel dizzy after a cruise is the significant changes in sensory input that occur onboard a ship. Our body relies on multiple sensory systems, including vision, the vestibular system, and proprioception, to maintain balance and spatial orientation. However, on a cruise ship, these sensory inputs can be altered, leading to sensations of dizziness and disorientation.

The visual environment plays a crucial role in providing cues for our brain to understand our position and movement in space. Normally, we rely on a stable horizon or fixed objects to orient ourselves. However, on a ship, the visual surroundings are constantly in motion. The horizon shifts, objects sway, and there are limited stable reference points. This discrepancy between what our eyes see and what our other sensory systems perceive can create confusion in the brain and contribute to feelings of dizziness.

The vestibular system, which is responsible for detecting motion and maintaining balance, is also affected by the changes in sensory input on a cruise ship. The constant rocking and swaying motion of the ship can stimulate the vestibular system and challenge its ability to adapt. The conflicting signals from the inner ear and visual system can disrupt the normal functioning of the vestibular system and result in dizziness.

Proprioception, the sense of body position and movement detected by receptors in our muscles and joints, is another sensory input that can be affected on a cruise ship. The constant changes in body position and the need to adjust to the ship’s movements can throw off our proprioceptive feedback. This can lead to a sense of unsteadiness and contribute to the feelings of dizziness.

It’s important to note that not everyone experiences the same degree of dizziness due to changes in sensory input. Some individuals may have a higher threshold for adapting to these changes or may be more sensitive to the alterations in their environment. Factors such as age, prior history of motion sickness, and individual differences in sensory processing can influence the susceptibility to dizziness.

Addressing the changes in sensory input on a cruise ship can help alleviate post-cruise dizziness. Taking measures to find stable visual reference points, such as focusing on the horizon or choosing a cabin with windows that provide a steady view, can assist in reducing the conflicting signals received by the brain. Additionally, practicing gentle movements and maintaining proprioceptive awareness through exercises like tai chi or yoga can help improve balance and minimize the impact of sensory disturbances.

By understanding and adapting to the changes in sensory input that occur on a cruise ship, individuals can better manage dizziness and enhance their overall cruising experience. In the following sections, we’ll explore additional strategies and remedies to alleviate post-cruise dizziness and promote a smoother transition back to solid ground.

Effects of Seasickness Medication

Seasickness medication is a commonly used preventative measure and treatment for individuals prone to motion sickness while on a cruise. These medications, often available over-the-counter or by prescription, can help alleviate the symptoms of motion sickness. However, it’s important to be aware of the potential effects they may have, including those related to dizziness.

One of the main types of seasickness medication is antihistamines. These medications work by blocking histamine receptors in the brain, which can help reduce motion sickness symptoms, such as nausea and vomiting. However, antihistamines can also have side effects that can contribute to dizziness. Common side effects include drowsiness, dizziness, and impaired coordination.

For individuals who experience dizziness after taking seasickness medication, it may be a result of the sedating effects of the medication. The drowsiness and fatigue caused by antihistamines can amplify the sensation of dizziness, making it more challenging to maintain balance and stability. If you find that the medication leaves you feeling excessively dizzy or unsteady, it may be worth exploring alternative options or adjusting the dosage under the guidance of a healthcare professional.

Another seasickness medication that is sometimes used is scopolamine, which is available as a patch applied behind the ear. Scopolamine helps block the signals from the inner ear that can trigger nausea and vomiting. While scopolamine generally has fewer drowsiness-related side effects compared to antihistamines, it can still potentially contribute to dizziness, particularly if it is used in higher doses.

It’s important to note that not everyone will experience dizziness as a side effect of seasickness medication. Each individual may react differently, and some may find that the benefits of the medication outweigh any potential side effects. However, it’s always recommended to be cautious and attentive to how your body responds to medication. Consulting with a healthcare professional can provide personalized guidance and recommendations for finding the most suitable seasickness medication for your specific needs.

In addition to the potential for dizziness, seasickness medication can also have other side effects. Dry mouth, blurred vision, and urinary retention are among the common side effects associated with some antihistamines. Scopolamine can cause dry mouth, drowsiness, and dilated pupils. It’s important to read the medication’s instructions carefully and follow the recommended dosage to minimize the risk of side effects.

Ultimately, seasickness medication can be an effective tool for managing motion sickness on a cruise. However, if you experience dizziness or any other concerning side effects, it’s essential to consult with a healthcare professional to discuss alternatives or adjust the dosage. By finding the right balance, you can enjoy your cruise without the discomfort of post-cruise dizziness.

Dehydration and Dizziness

Dehydration is a common concern on cruise ships, especially in warm climates or during activities that cause increased sweating. When your body doesn’t have enough fluids, it can lead to various symptoms, including dizziness. Understanding the relationship between dehydration and dizziness can help you stay hydrated and avoid these uncomfortable sensations.

Spending time on a cruise ship, particularly in sunny and tropical destinations, can result in increased fluid loss through sweating. Activities like sunbathing, participating in water sports, or exploring ports of call can further contribute to fluid loss. When your body doesn’t have enough fluids, it can affect your blood pressure and lead to a drop in volume. Low blood pressure can reduce blood flow to the brain, resulting in dizziness.

In addition to the direct impact on blood pressure, dehydration can also affect the balance of electrolytes in the body. Electrolytes are minerals that play a crucial role in maintaining proper nerve and muscle function, including those responsible for maintaining balance. When electrolyte levels are imbalanced due to dehydration, it can disrupt the normal functioning of the nervous system and lead to dizziness.

Dehydration can sometimes be subtle, and you may not realize you’re experiencing it until symptoms like dizziness or thirst become pronounced. It’s important to stay vigilant and prioritize hydration during your cruise. Drinking enough water throughout the day, especially when engaging in activities that cause excessive sweating, is crucial for preventing dehydration and the associated dizziness.

It’s important to note that not all drinks are equally effective for hydration. Alcoholic beverages and caffeinated beverages like coffee or soda can actually increase fluid loss as they have a diuretic effect. While it’s okay to enjoy these beverages in moderation, it’s wise to balance them with an adequate intake of water to maintain hydration levels.

Aside from dizziness, other signs and symptoms of dehydration may include thirst, dry mouth, dark-colored urine, fatigue, and decreased urine output. If you notice any of these signs, it’s important to increase your fluid intake promptly.

Preventing dehydration can go a long way in reducing the likelihood of experiencing dizziness after a cruise. Remember to drink plenty of water throughout the day, especially when exposed to hot and humid conditions or engaging in physical activities. Staying aware of your body’s thirst cues and responding with hydration can help you maintain optimal fluid balance and ensure a comfortable cruising experience.

If you do experience dizziness due to dehydration, it’s essential to address the issue promptly. Find a cool and shaded area, rest, and drink water or fluids that contain electrolytes to rehydrate your body. If symptoms persist or worsen, it’s advisable to seek medical assistance.

Anxiety and Stress

Anxiety and stress can significantly contribute to feelings of dizziness after a cruise. Cruising, with its unfamiliar surroundings, crowds, and new experiences, can sometimes trigger anxiety or stress in individuals. The anticipation or fear of feeling unsteady can also play a role in heightening these emotions.

When you experience anxiety or stress, your body goes into “fight-or-flight” mode, triggering a cascade of physiological responses. One of the physical manifestations of anxiety is muscle tension, including in the muscles that control balance and posture. This increased muscle tension can disrupt the body’s ability to maintain stability, leading to feelings of dizziness or unsteadiness.

Anxiety and stress can also affect the autonomic nervous system, which controls essential functions like heart rate, blood pressure, and breathing. In some individuals, the heightened state of anxiety can cause changes in blood pressure, leading to dizziness. The release of stress hormones, such as cortisol, can further contribute to these symptoms.

Furthermore, anxiety and stress can have a cognitive impact, affecting your perception of your surroundings and exacerbating sensations of dizziness. When your mind is preoccupied with worry or fear, it can be challenging to focus on maintaining balance and coordination, leading to a heightened perception of dizziness.

To mitigate the impact of anxiety and stress on post-cruise dizziness, it’s important to address these psychological factors. There are several strategies you can employ to manage anxiety and stress, including relaxation techniques, mindfulness exercises, and deep breathing exercises. These practices can help activate the body’s relaxation response and reduce feelings of dizziness.

Engaging in activities that promote relaxation and stress reduction, such as yoga or meditation, can also be beneficial. These practices can help calm the mind, reduce muscle tension, and improve overall well-being. It’s important to find techniques that resonate with you and incorporate them into your routine during and after the cruise.

Communication and support from fellow travelers, family, or friends can also help reduce anxiety and stress. Sharing your concerns with others can provide reassurance and perspective, easing any worries you may have about feeling dizzy after a cruise.

If anxiety and stress persist and significantly impact your daily life, it may be helpful to seek professional support, such as counseling or therapy. A mental health professional can provide guidance and techniques to manage anxiety and minimize its impact on dizziness.

By addressing anxiety and stress both during and after a cruise, you can better manage any feelings of dizziness and enjoy the experience to its fullest. Prioritizing self-care, relaxation, and seeking support when needed can go a long way in reducing the impact of anxiety and stress on post-cruise dizziness.

Remedies for Post-Cruise Dizziness

Experiencing dizziness after a cruise can be uncomfortable, but there are several remedies and strategies you can employ to alleviate these symptoms. By addressing the underlying causes and taking proactive measures, you can mitigate post-cruise dizziness and ensure a smoother transition back to solid ground. Here are some remedies to consider:

• Stay well-hydrated: Dehydration can contribute to dizziness, so it’s essential to drink plenty of water throughout your cruise and afterward. This can help maintain proper fluid balance and blood pressure levels.
• Take breaks and rest: Give yourself regular breaks from activities that may exacerbate dizziness. Find a quiet spot, sit down, and relax until the sensation subsides. Resting can help your body adjust and regain its equilibrium.
• Focus on stable visual points: When experiencing dizziness, find a stable visual reference point, such as the horizon or a fixed object in the distance. Directing your gaze towards something steady can help reorient your senses and alleviate the sensation of dizziness.
• Practice relaxation techniques: Calming the mind and reducing stress can help alleviate dizziness associated with anxiety. Techniques such as deep breathing, meditation, or yoga can promote relaxation and restore a sense of balance.
• Adjust your medication: If you are taking seasickness medication and it leads to dizziness or other uncomfortable side effects, consider adjusting the dosage or exploring alternative options under the guidance of a healthcare professional.
• Gradually acclimate to land: Ease the transition back to solid ground by gradually acclimating to stability. Rather than jumping into highly stimulating activities immediately upon disembarking, take some time to ground yourself through slow, steady movements.
• Consider vestibular rehabilitation: If dizziness persists or becomes disruptive to your daily life, vestibular rehabilitation therapy with a trained healthcare professional may be beneficial. This specialized therapy aims to improve balance and reduce dizziness through exercises and maneuvers.
• Consult with a healthcare professional: If your post-cruise dizziness is severe, persistent, or significantly interferes with your daily activities, it’s important to seek medical advice. A healthcare professional can assess your symptoms, provide additional remedies, and address any underlying medical conditions.

Remember, each individual may respond differently to remedies for post-cruise dizziness. It’s essential to find what works best for you through a process of trial and error. With proper self-care, awareness, and proactive measures, you can alleviate post-cruise dizziness and enjoy a smoother and more comfortable cruising experience.

Dizziness after a cruise is a common phenomenon experienced by many individuals. Understanding the various causes and underlying factors can help individuals better prepare for their cruises and take proactive measures to alleviate post-cruise dizziness.

Motion sickness, changes in sensory input, the vestibular system, and anxiety and stress all contribute to the sensation of dizziness after a cruise. Whether it’s the constant motion of the ship or the conflicting signals received by our sensory systems, these factors can disrupt our balance and increase feelings of dizziness.

Fortunately, there are several remedies and strategies to address post-cruise dizziness. Staying hydrated, finding stable visual points, practicing relaxation techniques, adjusting medication, gradually acclimating to stable ground, and considering vestibular rehabilitation can all help alleviate symptoms and promote a smoother transition.

It’s important to note that if symptoms persist or worsen, it’s advisable to seek medical advice. Consulting with a healthcare professional can provide personalized guidance and ensure there are no underlying medical conditions contributing to post-cruise dizziness.

By understanding the causes and implementing appropriate remedies, individuals can enjoy their cruising experiences without the discomfort of dizziness. Taking care of your physical and mental well-being, being mindful of your body’s needs, and seeking support when necessary can help you fully embrace the adventure and excitement of a cruise while minimizing the impact on your overall well-being.

Remember, each individual may respond differently to remedies, so it’s important to find what works best for you through trial and error. With proper preparation, awareness, and intervention, you can sail through your cruise with confidence, knowing that you are equipped to combat post-cruise dizziness and make the most of your memorable journey on the open seas.

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A Guide to Cruises and Vertigo

by Contractor | Nov 12, 2020 | resources , Travel Tips | 0 comments

Vertigo after a cruise ship vacation is quite common, especially among first-time cruise passengers . You’ll notice that the swaying and dizzy feeling that comes while you’re on board doesn’t go away even when you’ve disembarked from the ship. You may also find it difficult to gauge the distance from your foot to the floor and occasionally bump into objects trying to find your balance.

While the exact cause of vertigo after a cruise is unknown, there are things you can do to control it. First, you can give it time to pass on its own. It takes about two days for the symptoms to go away. If they don’t, it may be time to seek medical intervention.

Understanding how vertigo happens and what to expect will help you deal with the condition more effectively. We’ve provided a comprehensive guide on vertigo after a cruise and how to manage it. Let’s dive right in.

Understanding Vertigo after a Cruise Ship Vacation

You’ve returned home from a cruise, but your body still feels like you’re on the ship. You try to sleep or lie down, but everything around you seems to be moving. Sometimes you feel like your body is rocking or swaying and your legs seem weak. What’s happening?

The disorder is known as Mal de Debarquement Syndrome, also referred to as MdDS or MDD. It is a type of vertigo that occurs once you step out of a cruise ship. Most people experience the symptoms for a day or two, and they go back to normal. However, the symptoms persist for weeks or longer in some returning vacationers.

Common Symptoms

Individuals suffering from vertigo describe a feeling that’s equivalent to trying to walk on a trampoline. The symptoms begin as soon as one steps out of the cruise ship. Most people feel dizzy and find it hard to find their balance. Also, the symptoms seem to subside when one is in motion and reappear when they’re standing still.

Some of the common symptoms of vertigo after a cruise ship include:

• Extreme fatigue
• Motion sensation even when one is standing still
• Unsteady gait
• Difficulty concentrating
• Ear ringing

The symptoms vary from one day to another and can present differently for different people as well. However, they are worse during the night.

Source: Travel Tips USA Today

Who Is Most Affected?

MdDS commonly affects women aged 40 to 50 years following a 7-night cruise or more. In fact, reports show that 90% of MdDs cases are among women. The condition typically lasts for about a month or less but can continue longer than this.

What Causes Vertigo after Cruise Ship Vacation?

Understanding the course of this condition is the first step to finding a solution. Unfortunately, despite extensive research, scientists haven’t found the real cause of vertigo. However, findings show that it may be caused by the following:

Hormonal Changes

Some specialists speculate that hormonal changes and anxiety in middle-aged women may be a cause of vertigo after leaving a cruise ship. However, there isn’t enough evidence to support this.

Brain and Body Adaptations to Ship Movements

Another possible cause of vertigo is your body and brain’s natural adjustments to the movements of the ship. Your brain anticipates the swaying movements, thereby preventing you from falling. In turn, your body follows suit and this becomes our “normal” state.

After the cruise, your brain takes some time to get back to normal, hence the symptoms you experience. You’ll feel as if you’re still on the ship and everything around you will appear to be in motion. This explains why the symptoms seem to disappear when you get into a moving vehicle or you engage in an activity that requires a lot of movement. In most cases, this feeling will pass on its own after a few days.

Dizziness experts also believe that migraines may cause MdDS and increase the risk of motion sickness. A study showed that patients who were exposed to motion around the time of their period (commonly accompanied by migraines) experienced MdDS. This theory explains why some women have better tolerance for some cruises than others. However, there isn’t sufficient evidence to support this theory.

Source: Dizziness and Balance

Source:  NHS Inform

Treatment Options

If you’re diagnosed with Mal de Debarquement, your doctor will most likely advise you to see a physical therapist specializing in vestibular rehabilitation. The program involves various exercises aimed at improving balance and reducing dizziness-related symptoms.

After a few months of the therapy sessions, you should notice an improvement in your symptoms. However, going on another cruise or any activity that triggers Mal de Debarquement may cause another episode.

Your doctor may also prescribe some anti-anxiety medication that’s meant to be taken for a short while. Once the symptoms have begun, motion-sickness medicines won’t help.

Source: Cleveland Clinic

How to Cure Vertigo after a Cruise Ship Vacation

Therapy and anti-anxiety medication are prescribed to patients who have been suffering from vertigo for days on end without relief. If the symptoms are not chronic, there are several things you can do to cure it and get back to normal.

Get Quality Sleep

Getting enough sleep after a cruise can be all your body needs to heal and reset. When you get home from your cruise, resist the urge to do a lot. Pass on the alcohol and retire to bed early. You’ll feel so much better when you wake up.

If rest doesn’t do it, wait it out a few days. In most cases, the symptoms subside on their own after two or more days.

Try Some Vertigo-Easing Home Remedies

Some people swear by ginger when it comes to relieving vertigo symptoms. For the best results, make a drink from fresh ginger. You can also try acupressure wrist bands, which are excellent for relieving sea-sickness and are believed to be equally beneficial for curing post-cruise vertigo.

Other home remedies believed to ease the symptoms include:

• Gingko Biloba extract capsules
• Deep breathing techniques to ease stress
• Avoiding alcohol

Stay Active

As we mentioned, vertigo seems to get better when you’re in motion. Therefore, when you start experiencing these symptoms, it’s crucial to stay active. Physical activity not only improves blood circulation but also does wonders for your hand and eye coordination.

See a Doctor

If you tried sleeping, home remedies, and physical activity, and nothing seems to work; it may be time to see a doctor, especially if the symptoms have lasted more than two days. In this case, you may be suffering from a severe case of MdDS that requires medical intervention to cure.

Find Your Balance

Cruises are fun. You get to enjoy uninterrupted time and make lasting memories. But if you tend to suffer from land sickness, the aftermath of your cruise is far from fun. Most people have a difficult time doing basic things like taking a shower because everything seems to be spinning out of control.

It doesn’t have to come to this. If you’ve had this experience before, it may be a good idea to talk to your doctor before embarking on your trip. They may have some tricks to help you cope more effectively.

And if you’re already dealing with the symptoms, try the techniques listed in this article, they work wonders for less severe cases, and you’ll notice an improvement within a few days.  However, if the symptoms persist, be sure to seek medical advice.

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After Cruise Motion Sickness: Causes, Symptoms, and Treatment Options

Do you ever feel like you’re still on a cruise ship even after you’ve returned home? Do you experience symptoms such as dizziness, nausea, and a rocking sensation that just won’t go away?

If so, you may be suffering from a condition known as mal de debarquement syndrome (MdDS).

MdDS is a rare motion disorder that affects some people after they disembark from a boat or ship. Symptoms can persist for days, weeks, or even months after the cruise has ended, making it difficult for sufferers to resume their daily activities.

While the exact cause of MdDS is not fully understood, it is believed to be related to a mismatch between the brain’s perception of motion and the body’s actual movement.

Fortunately, there are ways to manage the symptoms of MdDS and get your land legs back. From medication to natural remedies, there are various options available to help alleviate the discomfort associated with this condition.

In this article, we will explore the causes and MdDS symptoms, as well as the most effective treatments for after-cruise motion sickness.

Understanding Motion Sickness

The inner ear, also known as the vestibular system, is responsible for maintaining your body’s sense of balance and orientation. When you are in motion, the vestibular system sends signals to your brain to help it understand your body’s position and movement.

However, if your eyes see something different from what your inner ear is sensing, it can cause a conflict in your brain, leading to motion sickness.

After cruise motion sickness (aka land sickness) can affect anyone, but some people are more susceptible to it than others. Women, children under 12, and people with a history of migraines or inner ear problems are more likely to experience this balance disorder.

Symptoms include nausea, vomiting, dizziness, sweating, and fatigue. These symptoms can be mild or severe and can last for minutes or hours, depending on the severity of the motion sickness.

To prevent land sickness, it is important to avoid activities that can trigger it, such as reading while in motion or sitting in the backseat of a car. It is also helpful to keep your eyes fixed on a stable object, such as the horizon, and to avoid looking at moving objects.

If you do experience such symptoms, there are several remedies that can help alleviate the nausea. These include taking over-the-counter medications, such as antihistamines or ginger supplements, and practicing deep breathing and relaxation techniques.

Specifics of After Cruise Motion Sickness

After a cruise, it’s common to feel like you’re still on the ship for a short period of time. This feeling is known as “sea legs” and is caused by your brain still adjusting to being back on land.

However, for some people, the symptoms of motion sickness can persist for days or even weeks after the cruise has ended. This is known as after cruise motion sickness or mal de debarquement syndrome (MDDS) .

MDDS is a rare condition that affects a small percentage of people who have been on a cruise. The symptoms of MDDS can include a persistent feeling of rocking or swaying, dizziness, nausea, and fatigue. These symptoms can be mild or severe and can last for days, weeks, or even months.

The exact cause of MDDS is unknown, but it is believed to be caused by a mismatch between the signals that your brain receives from your inner ear and your eyes. This mismatch can cause your brain to continue to perceive motion even when you are stationary, leading to the symptoms of MDDS.

If you are experiencing symptoms of MDDS after a cruise, it’s important to seek medical attention. Your doctor may be able to recommend treatments such as medication or physical therapy to help alleviate your symptoms.

It’s also important to take steps to prevent MDDS before and during your cruise. This can include taking medication to prevent motion sickness, staying hydrated, and avoiding alcohol and caffeine. Additionally, during the cruise, you can try to stay in the middle of the ship, where there is less motion, and avoid looking at the ocean or other moving objects.

Symptoms of Land Sickness

If you have ever experienced motion or land sickness, you know how uncomfortable it can be. The symptoms can vary from person to person, but some common symptoms include:

These symptoms can last for hours or even days, depending on the severity of your motion sickness. In some cases, you may experience migraines or headaches as well.

One of the most common symptoms is imbalance. You may feel like you are swaying or rocking, even when you are standing still. This can make it difficult to maintain your balance and can lead to falls.

In addition to imbalance, you may also experience tiredness and fatigue. This can make it difficult to focus and can affect your overall mood. Some people even experience depression as a result of their motion sickness.

If you are experiencing any of these symptoms, it is important to take steps to manage your motion sickness. This may include taking medication, avoiding certain foods or activities, or using relaxation techniques to reduce anxiety.

How to Prevent Land Sickness After Your Cruise

While there is no foolproof method to prevent land sickness, you can take certain steps to help minimize its effects:

• Gradual Adjustment: Give your body time to readjust to the stable ground. Avoid making sudden movements and take it easy during the first few days after disembarking from the cruise ship.
• Stay Hydrated: Drink plenty of water to stay hydrated, as dehydration can worsen the symptoms of land sickness.
• Get Adequate Rest: Allow your body to recover from the physical and sensory changes experienced during the cruise. Get enough sleep to aid in the readjustment process.
• Avoid Stimulants: Limit the intake of caffeine, alcohol, and other stimulants that can disrupt your body’s natural equilibrium.
• Focus on the Horizon: When walking or standing, try to focus on the horizon or a stable object in the distance. This can help your brain reorient itself and reduce the sensation of movement.
• Avoid Prolonged Screen Time: Minimize excessive screen time, such as watching TV or using a computer, as this can exacerbate symptoms.
• Motion Exercises: Gentle motion exercises, like rocking or swaying slowly while sitting or standing, might help your body adapt to the changes.
• Balance Training: Engage in simple balance exercises, like standing on one leg or walking in a straight line, to improve your body’s balance mechanisms.
• Deep Breathing and Relaxation Techniques: Practicing deep breathing and relaxation exercises can help reduce stress and alleviate symptoms.
• Consult a Healthcare Professional: If the symptoms persist or become severe, consult a healthcare professional experienced in treating motion-related issues or vestibular disorders.

It’s important to remember that land sickness usually resolves on its own within a few days to a few weeks. However, if the symptoms persist for an extended period or interfere with your daily life, it’s best to seek medical advice.

As with any medical condition, individual responses may vary, and the effectiveness of preventive measures can differ from person to person.

If you are concerned about land sickness or have any underlying health conditions, consult a healthcare professional for personalized advice and guidance

Preventing Motion Sickness on Your Cruise

If you’re planning a cruise, you may be worried about getting motion sickness. Fortunately, there are several ways to prevent it.

Choose Your Cabin Wisely

When booking your cabin, try to choose one in the middle of the ship. This is the most stable area of the ship and will experience the least amount of movement. Additionally, cabins that are located on lower decks tend to experience less motion than those on higher decks.

Take Advantage of Stabilizers and Hull Design

Modern cruise ships are equipped with stabilizers that help reduce the amount of rolling and pitching. Additionally, the hull design of newer ships is optimized to reduce motion. When booking your cruise, try to choose a newer ship that has these features.

Look at the Horizon

When you’re on the ship, try to focus on the horizon. This can help reduce the feeling of motion sickness. Avoid looking at anything that is moving, such as the waves or other passengers.

Avoid Reading

Reading while on a moving ship can make motion sickness worse. If you’re prone to motion sickness, try to avoid reading while on the ship.

Get Fresh Air

If you’re feeling queasy, try to get some fresh air. Go outside on the deck and take deep breaths. This can help you feel better.

Avoid Windy Areas

Windy areas of the ship can exacerbate motion sickness. Try to avoid areas where there is a lot of wind.

Medications

If you’re prone to motion sickness, talk to your doctor about medications that can help prevent it. There are several over-the-counter and prescription medications that can be effective. However, be aware that some medications can cause drowsiness.

Motion Sickness Medications

Meclizine is an over-the-counter medication that come as motion sickness pills. It is an antihistamine that works by blocking the effects of histamine, a chemical in the body that can cause nausea and vomiting. Meclizine is available in tablet form and should be taken at least one hour before traveling.

Scopolamine is a prescription medication that is available in patch form. It is a type of anticholinergic medication that works by blocking the effects of acetylcholine, a chemical in the body that can cause nausea and vomiting. The patch should be applied behind the ear at least four hours before traveling and can be effective for up to three days.

Dramamine is an over-the-counter medication that can be used to treat motion sickness. It contains the active ingredient dimenhydrinate, which is an antihistamine that can help alleviate nausea and vomiting. Dramamine is available in tablet or liquid form and should be taken at least 30 minutes before traveling.

It is important to note that these medications can cause drowsiness as a side effect, so it is recommended that you avoid driving or operating heavy machinery while taking them.

Additionally, some medications may interact with other medications you are taking, so it is important to speak with your healthcare provider before taking any new medication.

Natural Remedies for Motion Sickness

If you’re looking for natural remedies to help ease your motion sickness after a cruise, there are several options to consider. These remedies can help alleviate symptoms like nausea, dizziness, and vomiting.

One of the most popular natural remedies for motion sickness is ginger. Ginger has been used for centuries to treat nausea and vomiting, and studies have shown that it can be effective in reducing symptoms of motion sickness as well. You can try drinking ginger tea or taking ginger supplements to help alleviate your symptoms.

2. Fresh Air

Another natural remedy is fresh air. When you’re feeling nauseous or dizzy, getting some fresh air can help provide relief. If possible, step outside onto the deck of the ship or open a window in your cabin to get some fresh air.

3. Acupressure Bands

You may also want to try using acupressure bands. These bands apply pressure to certain points on your wrist that are believed to help alleviate nausea and vomiting. They are safe, easy to use, and can be found at most drugstores.

4. Peppermint

Peppermint is another natural remedy that can be effective in reducing symptoms of motion sickness. Peppermint has a calming effect on the stomach and can help alleviate nausea. You can try drinking peppermint tea or using peppermint essential oil to help ease your symptoms.

5. Green Apples

Green apples are believed to help with motion sickness due to their natural acidity and fresh aroma. Green apples have a slightly higher level of acidity than other apple varieties. Some people claim that the acidity can help neutralize stomach acids, reducing feelings of nausea and discomfort associated with motion sickness. (I got ill on a cruise one time from large waves and I ate half a green apple with some sprite and within 20 min I was feeling much, MUCH better).

6. Alcohol Pads

Smelling alcohol pads for nausea is a home remedy that some people use to try and alleviate feelings of nausea. The idea behind this practice is that the strong scent of the alcohol might help to distract from or mask the sensation of nausea. Additionally, some believe that the alcohol’s volatile compounds could have a calming effect on the stomach.

If you’re looking for a medication that is considered natural, you may want to consider Bonine. Bonine is an over-the-counter medication that contains meclizine, an antihistamine that can help alleviate symptoms of motion sickness. It is considered safe and effective for most people.

8. Acupuncture

Finally, acupuncture is an alternative therapy that can be effective in reducing symptoms of motion sickness. Acupuncture involves the insertion of thin needles into specific points on the body, and it is believed to help promote balance and alleviate nausea and vomiting.

Tips for Traveling with Motion Sickness

Motion sickness can be a real bummer when you’re traveling, especially after a cruise vacation. But don’t let it hold you back from exploring the world. Here are some tips to help you manage motion sickness while traveling:

Choose the Right Mode of Transportation

Some modes of transportation can trigger motion sickness more than others. If you know you’re prone to motion sickness, try to avoid cars, buses, and trains that have a lot of sudden stops and starts. Instead, opt for a cruise ship or plane, which tend to have smoother rides. If you’re traveling by car, try to sit in the front seat and focus on the road ahead.

Choose the Right Seat

When traveling by plane or cruise ship, try to choose a seat near a window or with access to fresh air. Being able to see the horizon can help with motion sickness, and fresh air can help alleviate symptoms. If you’re on a cruise ship, consider booking a stateroom with a balcony so you can step outside whenever you need to.

Pack the Right Supplies

There are several over-the-counter medications and natural remedies that can help with motion sickness. Ginger, for example, has been shown to be effective in reducing nausea and vomiting. You can take ginger supplements or bring ginger tea or candies with you on your trip. Other options include acupressure wristbands, which apply pressure to a specific point on your wrist to help alleviate symptoms, and over-the-counter medications like Dramamine.

Take Breaks

If you’re on a long trip, make sure to take breaks and get some fresh air whenever possible. Take a walk around the plane or cruise ship, or step outside for a few minutes if you’re traveling by car. Taking breaks can help reset your senses and alleviate motion sickness symptoms.

By following these tips, you can manage motion sickness and enjoy your travels without feeling sick. Remember, everyone’s experience with motion sickness is different, so it’s important to find what works best for you.

Specific Groups Affected by Motion Sickness

Motion sickness can affect anyone, regardless of age or gender. However, some groups may be more prone to motion sickness than others. Here are some specific groups that may be affected by motion sickness:

Studies have shown that women are more likely to experience motion sickness than men. This may be due to hormonal differences, as women’s levels of estrogen and progesterone fluctuate throughout their menstrual cycle. These hormones can affect the vestibular system, which is responsible for maintaining balance and spatial orientation.

Middle-aged Women

Middle-aged women are particularly susceptible to motion sickness, especially during the perimenopausal and menopausal periods. This is because hormonal changes during this time can disrupt the vestibular system, making it more sensitive to motion.

Pregnant Women

Pregnant women may experience motion sickness due to hormonal changes, increased sensitivity to sensory stimuli, and changes in balance and coordination. Additionally, many anti-motion sickness medications are not safe for pregnant women to take, so it’s important to talk to your doctor before taking any medication.

Children are also prone to motion sickness, especially those between the ages of 2 and 12. This is because their vestibular system is still developing, and they may not have fully developed their ability to suppress conflicting sensory information.

In general, anyone can experience motion sickness, but some groups may be more susceptible to it than others. If you fall into one of these groups, it’s important to take preventative measures to avoid motion sickness, such as sitting in the front of a car or boat, focusing on a fixed point in the distance, and avoiding reading or looking at screens while in motion.

Diagnosing Land Sickness

If you are experiencing symptoms of land sickness after a cruise, it is important to seek medical attention from a doctor or medical professional. Your doctor will begin by taking your medical history and performing a physical exam to check for any underlying conditions that may be contributing to your symptoms.

In some cases, your doctor may refer you to a neurologist, who specializes in disorders of the nervous system. They may also order blood tests or a hearing exam to rule out other possible causes of your symptoms.

One way that doctors diagnose motion sickness is by evaluating your internal models. These are the mental representations that your brain uses to predict how your body will move and react to different stimuli. When your internal models are disrupted, such as when you are on a moving ship, it can lead to symptoms of motion sickness.

Your doctor may also use a variety of other diagnostic tools to help diagnose your condition. For example, they may use a computerized dynamic posturography (CDP) test to evaluate your balance and stability. This test involves standing on a platform that moves in different directions while sensors measure your body’s response.

Dealing with Severe Motion Sickness

One effective treatment is vestibular rehabilitation. This therapy involves exercises that help you retrain your brain to process the signals it receives from your inner ear, which can help reduce your symptoms.

Your doctor may refer you to a physical therapist who specializes in vestibular rehabilitation to help you develop a personalized treatment plan.

Another condition that can cause persistent motion sickness is Mal de Debarquement Syndrome (MDDS). If you have been diagnosed with MDDS, your doctor may recommend medication to help manage your symptoms. Antidepressants and anti-anxiety medications can be effective in reducing the severity of your symptoms.

In addition to medication and therapy, there are other steps you can take to manage your motion sickness.

Here are a few tips that may help:

• Avoid reading or looking at screens while in motion
• Focus on a fixed point in the distance to help stabilize your vision
• Stay hydrated and avoid alcohol and caffeine
• Get plenty of rest and avoid overexertion

By taking these steps and working with your doctor to develop a treatment plan, you can manage your severe motion sickness and improve your quality of life.

Lifestyle and Motion Sickness

Motion or land sickness can be a frustrating and debilitating condition that can impact your daily life, especially after a cruise. While there is no guaranteed cure, there are several lifestyle changes and remedies that can help alleviate symptoms.

Regular exercise can help reduce the severity of motion sickness symptoms. Exercise increases blood flow and can help improve balance and coordination. However, it is important to avoid exercising immediately before or after a cruise, as this can exacerbate symptoms.

Getting enough rest before and after a cruise can help reduce the likelihood and severity of motion sickness. Lack of sleep can make symptoms worse, so it is important to prioritize rest and relaxation.

Dehydration

Dehydration can worsen motion sickness symptoms, so it is important to stay hydrated before, during, and after a cruise. Drinking plenty of water and avoiding alcohol and caffeine can help prevent dehydration and reduce symptoms.

Alcohol can worsen motion sickness symptoms, so it is important to avoid drinking alcohol before and during a cruise. If you do choose to drink, it is important to do so in moderation and to stay hydrated.

Hormonal changes can impact the severity of motion sickness symptoms, especially in women. If you experience motion sickness during your menstrual cycle, consider talking to your doctor about hormonal birth control options.

Overall, making small lifestyle changes and taking preventative measures can help reduce the severity and frequency of motion sickness symptoms after a cruise.

Devices for Motion Sickness Relief

When it comes to motion sickness relief, there are various devices you can use to prevent or alleviate symptoms. Here are some of the most popular options:

Wristbands are a common choice for motion sickness relief. They work by applying pressure to the Nei-Kuan acupressure point on your wrist, which is believed to help reduce nausea. There are two types of wristbands: elastic bands with a plastic stud and battery-powered bands that use electrical stimulation. Both types are designed to be worn on both wrists and can be adjusted for a comfortable fit.

Anti-Nausea Medication

If you’re prone to motion sickness, you may want to consider taking anti-nausea medication before your cruise. There are several over-the-counter and prescription medications available, including Dramamine, Bonine, and Scopolamine patches. These medications work by blocking the signals that cause nausea in your brain. It’s important to talk to your doctor before taking any medication to ensure it’s safe for you.

Sea-Bands are similar to wristbands but are worn on your ankles instead. They work by applying pressure to the Pericardium 6 (P6) acupressure point, which is believed to help relieve nausea and vomiting. Sea-Bands are a good option if you prefer not to wear something on your wrists or if you find wristbands uncomfortable.

The ReliefBand is a battery-powered wristband that uses electrical stimulation to prevent nausea and vomiting. It works by sending gentle pulses to the median nerve on your wrist, which helps to rebalance your body’s natural electrical signals. The ReliefBand is FDA-approved and has been clinically proven to be effective for motion sickness relief.

Ginger is a natural remedy that has been used for centuries to treat nausea and vomiting. You can take ginger supplements, drink ginger tea, or eat ginger candy to help prevent motion sickness. Some people find that nibbling on plain crackers and sipping cold water or a carbonated drink without caffeine also helps.

Overall, there are several devices and remedies available to help prevent or alleviate motion sickness symptoms. It’s important to find the option that works best for you and to talk to your doctor before taking any medication.

Side Effects of Motion Sickness Medications

When you experience motion sickness, you may want to take medication to alleviate the symptoms. However, like any medication, motion sickness drugs can have side effects. Here are some of the most common side effects you may experience when taking medication for motion sickness:

• Drowsiness : One of the most common side effects of motion sickness medication is drowsiness. This can be particularly problematic if you are driving or operating heavy machinery. If you experience drowsiness after taking medication, avoid driving or operating machinery until the drowsiness wears off.
• Dry mouth : Some motion sickness medications can cause dry mouth. This can be uncomfortable, but it is usually not a serious side effect. Drinking plenty of water can help alleviate dry mouth.
• Blurred vision : Some motion sickness medications can cause blurred vision. If you experience this side effect, avoid activities that require good vision, such as driving or reading.
• Dizziness : Dizziness is another possible side effect of motion sickness medication. If you experience dizziness, avoid activities that require balance, such as walking on uneven ground or climbing stairs.
• Nausea : Ironically, some motion sickness medications can cause nausea as a side effect. If you experience nausea after taking medication, try taking it with food or a full glass of water.

It’s important to note that not everyone will experience these side effects, and some people may experience side effects that are not listed here. If you have concerns about the side effects of a particular medication, talk to your doctor or pharmacist.

In some cases, the benefits of taking motion sickness medication may outweigh the potential side effects. However, it’s important to be aware of the possible side effects so you can make an informed decision about whether to take medication for your motion sickness symptoms.

The Role of the Inner Ear in Motion Sickness

Motion sickness is a common phenomenon that affects many people, especially after a cruise. The inner ear plays a crucial role in motion sickness. The inner ear is responsible for detecting movement and changes in the body’s position, which helps the brain maintain balance.

The inner ear consists of three semicircular canals filled with fluid and tiny hair-like sensors. These sensors detect the movement of fluid as the head moves. The information is then sent to the brain, which processes the signals and sends messages to the muscles to maintain balance.

When you are on a cruise, the movement of the ship can cause the fluid in the inner ear to move in a way that is different from the movement of the body. This can cause a conflict in the signals being sent to the brain, leading to motion sickness.

The inner ear is not the only factor that contributes to motion sickness. Other factors, such as visual cues and the body’s position, also play a role. For example, if you are reading a book or looking at your phone while on a moving ship, your eyes may send signals to the brain that conflict with the signals from the inner ear, leading to motion sickness.

In conclusion, the inner ear plays a crucial role in motion sickness. It detects movement and changes in the body’s position, which helps the brain maintain balance. When the signals from the inner ear conflict with other signals, such as visual cues, it can lead to motion sickness.

The Influence of the Ocean on Motion Sickness

If you experience motion sickness after a cruise, you may wonder why the ocean has such a strong effect on your body. The truth is that the ocean’s movement and the resulting motion sickness are closely related. Here are a few factors that influence motion sickness when you’re on a cruise:

• Wave frequency and amplitude : The ocean’s waves can have different frequencies and amplitudes, depending on the weather and other factors. When the waves are high and frequent, your body may have a harder time adapting to the motion, which can lead to motion sickness.
• Visual cues : When you’re on a cruise, your eyes may see the ship moving, but your body may not feel it. This mixed signal can confuse your brain and trigger motion sickness.
• Inner ear balance : Your inner ear is responsible for maintaining your body’s balance. When you’re on a cruise, the constant motion of the ship can affect your inner ear and make you feel dizzy or nauseous.
• Stress and anxiety : Feeling stressed or anxious can make motion sickness worse. If you’re worried about getting sick or have other concerns about your cruise, it can amplify the symptoms of motion sickness.

Overall, the ocean’s movement can have a significant impact on your body and trigger motion sickness. However, there are ways to prevent and manage motion sickness when you’re on a cruise.

The Role of Timothy C. Hain in Motion Sickness Research

Timothy C. Hain is a neurologist and researcher at Northwestern University who has made significant contributions to the study of motion sickness. His work has focused on understanding the underlying causes of motion sickness and developing effective treatments for this common condition.

Hain has conducted extensive research on various types of motion sickness, including seasickness, car sickness, and air sickness. He has also studied the role of the vestibular system in motion sickness and the use of medication and other interventions to prevent or alleviate symptoms.

One of Hain’s most significant contributions to the field of motion sickness research is his work on Mal de Debarquement Syndrome (MdDS). This condition is characterized by a persistent feeling of motion or rocking, even after a person has returned to solid ground after a cruise or other extended period at sea. Hain’s research has helped to shed light on the underlying causes of MdDS and identify effective treatment options for those who suffer from this debilitating condition.

Hain’s research has also focused on the use of virtual reality and other technologies to simulate motion and help people overcome motion sickness. He has worked with a team of researchers to develop a virtual reality system that can be used to treat motion sickness in a clinical setting.

Overall, Timothy C. Hain’s research has helped to advance our understanding of motion sickness and improve treatment options for those who suffer from this condition. His work has been instrumental in developing new treatments and interventions that can help people overcome the symptoms of motion sickness and enjoy travel and other activities without discomfort.

The Cleveland Clinic and Motion Sickness

The Cleveland Clinic explains that motion sickness occurs when your brain can’t make sense of information sent from your eyes, ears, and body.

Lots of motion, whether on a car, airplane, boat, or even an amusement park ride, can make you feel queasy, clammy, or sick to your stomach. Some people may even vomit. Being carsick, seasick, or airsick is motion sickness.

The Cleveland Clinic offers several recommendations to help prevent motion sickness.

These include:

• Focusing on a fixed point in the distance
• Avoiding alcohol and greasy or spicy foods
• Getting fresh air
• Taking breaks to walk around
• Using over-the-counter medications, such as Dramamine or Bonine

If you’re still experiencing motion sickness symptoms after your cruise, the Cleveland Clinic recommends seeing a healthcare provider. They can help determine if you’re experiencing mal de debarquement syndrome, a rare condition that causes a feeling of motion sickness even after you’re no longer in motion.

Walking and Motion Sickness

Walking is a great way to alleviate motion sickness after a cruise. It helps your body adjust to being on land again and can reduce the feeling of dizziness and nausea.

Here are some tips to make walking more effective in reducing motion sickness:

• Start slow: Begin with a gentle stroll and gradually increase your pace as you feel more comfortable. Don’t push yourself too hard too soon.
• Focus on your surroundings: Look at the scenery around you, the trees, buildings, people, and animals. This will help your brain adjust to the new environment and reduce the feeling of disorientation.
• Take deep breaths: Inhale deeply through your nose and exhale slowly through your mouth. This can help calm your nerves and reduce anxiety, which can exacerbate motion sickness.
• Stay hydrated: Drink plenty of water before and during your walk. Dehydration can worsen motion sickness symptoms.
• Avoid heavy meals: Don’t eat a large meal before walking or during the walk. Stick to light snacks like fruits or nuts.
• Wear comfortable shoes: Choose comfortable shoes with good support. This will help you maintain your balance and prevent falls.

Walking after a cruise can be an effective way to reduce motion sickness symptoms. It helps your body adjust to being on land again and can reduce the feeling of dizziness and nausea. By following these tips, you can make the most of your walk and start feeling better sooner.

Frequently Asked Questions

Q: how do you get rid of motion sickness after a cruise.

A: Land sickness after a cruise can be uncomfortable, but it usually goes away on its own within a few days. However, there are some things you can do to alleviate the symptoms. Drinking plenty of fluids and staying hydrated can help reduce nausea and dizziness.

Ginger, either in the form of ginger ale or ginger supplements, is a natural remedy that may help ease motion sickness. Over-the-counter medications, such as meclizine or dimenhydrinate, can also be effective in treating motion sickness.

Q: How long does it take for motion sickness to go away after a cruise?

A: Motion sickness after a cruise can last for a few days to a few weeks, depending on the severity of the symptoms. Most people start to feel better within a few days of returning home, but some may experience lingering symptoms for a few weeks after the cruise.

Q: How long does post cruise vertigo last?

A: Post-cruise vertigo, also known as disembarkation syndrome, can last for a few days to a few weeks. The symptoms usually go away on their own, but in some cases, they may last for several months. If you are experiencing severe vertigo, you should consult a doctor.

Q: What are the symptoms of disembarkation sickness?

A: Disembarkation sickness, also known as mal de debarquement syndrome, can cause a range of symptoms, including dizziness, vertigo, nausea, headache, and fatigue. Some people may also experience difficulty with balance and coordination.

Q: What is the treatment for disembarkation sickness?

A: There is no specific treatment for disembarkation sickness, but symptoms can be managed with medications such as benzodiazepines and antihistamines.

Vestibular rehabilitation therapy, which involves exercises to improve balance and coordination, may also be helpful for some people.

Q: Are there any patches for post-cruise motion sickness?

A: Yes, there are patches available that can help alleviate post-cruise motion sickness. These patches contain scopolamine, a medication that can help reduce nausea and dizziness.

However, scopolamine can cause side effects such as dry mouth, blurred vision, and drowsiness, so it’s important to consult a doctor before using this medication.

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Mal de Debarquement Syndrome (MdDS)

Timothy C. Hain, MD • Page last modified: April 7, 2024

See also: MdDS calculator • MdDS treatment .• OKN stimulator

Mal de Debarquement or "MdDS" is a type of vertigo and imbalance that mainly occurs after getting off of a boat. The usual situation is that of a middle aged woman who has gone on a cruise. The diagnosis is entirely based on symptoms. See MdDS calculator There are several recent reviews of MdDS-- including Van Ombergen et al (2015), and Hain and Cherchi (2016), as well as efforts made to differentiate it from other dizzy symptom inventories such as vestibular migraine and PPPD . (Cha et al, 2020; Beh et al, 2021)

To our knowledge, the first potential reference to the syndrome was made by Erasmus Darwin, in 1796. He wrote:

"Those, who have been upon the water in a boat or ship so long, that they have acquired the necessary habits of motion upon that unstable element, at their return on land frequently think in their reveries, or between sleeping and waking, that they observe the room, they sit in, or some of its furniture, to librate like the motion of the vessel. This I have experienced myself, and have been told, that after long voyages, it is some time before these ideas entirely vanish. The same is observable in a less degree after having travelled some days in a stage coach, and particularly when we lie down in bed, and compose ourselves to sleep; in this case it is observable, that the rattling noise of the coach, as well as the undulatory motion, haunts us. " (Darwin, 1796). A similar observation was made by Jack London in his book, Sea Wolf (1904) , who discusses "This was the startling effect of the cessation of motion. We had been so long upon the moving, rocking sea that the stable land was a shock to us. We expected the beach to lift up this way and that, and the rocky walls to swing back and forth like the sides of a ship; and when we braced ourselves, automatically, for these various expected movements, their non-occurrence quite overcame our equilibrium." If we look at both of these descriptions from the perspective of current definitions of MdDS (see below), neither mentions the duration and in particular, neither one documents a month of symptoms. So while they may document land sickness, they may not actually be about MdDS.

Some Cases:

A 50-year-old woman went on her first ocean cruise. She had some motion sickness on the cruise, which responded to transdermal scopolamine. Immediately after returning from the cruise and getting onto solid ground, she developed imbalance and a rocking sensation, accompanied by fatigue and difficulty concentrating. This persisted for months. She felt better however when she was driving. Her description was “Imagine feeling like you are on rough seas 24 hours a day, 7 days a week.” A related case ? An avid cross country skier noted that after she would come home from a day of skiing, she developed a sensation as if she was still skiing until she went to sleep. She was always fine in the morning. Many patients with MdDS or rocking symptoms say they have "motion memory" meaning that they feel as if they are moving after driving, or sometimes even just riding on an elevator.

General characteristics of MdDS

Table1: Characteristics of MdDS

Table 1 summarizes the available literature about MdDS as of 2008. Van Ombergen et al (2015) in a review, discovered far more patients than this, and the interested reader is referred to their paper. Also, Dai et al (2017) reported in a single study, about 120 patients. MdDS is a disorder that mainly affects women (85%) between 40-49 (Cha et al, 2020)s. Almost all individuals with MdDS are women. They typically have gone on a 7-day cruise. After getting off the boat, or "debarking" (debarquement), they immediately develop a rocking sensation, as if they are still on the boat. Here we define MdDS as rocking lasting for at least a month. This leaves the land-sickness group out. This definition was also used by the majority of studies reviewed by Van Ombergen et al (2015). In 2020, the self-described "consensus" committee of the Barany society both offered diagnostic criteria and also suggested a new naming system: MdDS is "in evolution" if the symptoms are ongoing for > 48 hours but the observation period has been less than a month, "transient" if they resolve at or before 1 months, and "persistent" if the symptoms last for more than a month (Cha et al, 2020). So if we just define the old MdDS as "persistent MdDS" using the new naming system, we have the same thing. Time will tell (pun intended) if this new system is useful.

The graph above is drawn on a much larger and more representative sample of patients than from our study of 1999, again mainly women (153/181 -- 85%), it shows that the distribution mainly includes females between the ages of 30-60. Although females predominate, for the treatment study of Dai et al (2017), positive effects of treatment were similar among genders. As of 2019, we have accumulated a few more than 300 patients with MdDS in our clinical files. Most patients with MdDS get better when they drive a motor vehicle. Some also are better when they are simply a passenger. This varies from the situation with Migraine patients or Meniere's patients , who generally get worse (Sharon and Hullar, 2014). Getting better when driving is actually not so rare -- many dizzy patients who certainly don't have MdDS report the same thing. Perhaps about 10%. More study of this is needed. Dai et al (2017) reported that their MdDS patients most commonly complained of rocking, swaying, bobbing, "gravity pulling", and "trampoline walking". They had a sway frequency that was predominantly 0.2 Hz. This is very slow -- with a full cycle occurring over about 5 seconds. Dai et al (2017) also noted that recurrent MdDS was reported by 23% of their 120 patients treated with "classic" MdDS.

How common is Mal de Debarquement ?

As of 2022, we had encountered 333 MdDS patients in our dizzy clinic database out of an "n" of about 30,000 patients with assigned diagnoses. This suggests that only roughly 1/100 dizzy patients have MdDS. As about 5% of the population develops "vestibular" dizziness per year, if we assume that our clinic sees MdDS as a representative proportion of all dizzy patients, a very very rough estimate as to the prevalence of MdDS is 0.05% (this is the same as 0.5/1000 persons). Or to put this into real-world terms, assuming 300 million persons in the United States, a 0.5 persons/1000 people prevalence works out to a total of 150,000 persons with MdDS in the US. Compared to land sickness (which happens in roughly 50% of persons who go on boats), MdDS is an unusual condition, and far less common than other dizzy conditions, say vestibular migraine (1% of population -- 3 million) or Meniere's disease (2/1000 people, 600,000 total in US or 0.2%). Note that this estimate could easily be wrong (probably too much) by an order of magnitude.

The figure above, from our 1999 paper, illustrates "worst case" durations -- it does not reflect the usual duration of symptoms. This is because the study group from our 1999 paper were persons with very severe MdDS. Cha et al (2008) stated that the median duration of symptoms is 4 months. Their data (figure 1) suggests that there were still roughly 15% of patients with symptoms longer than 60 months (i.e. 5 years). So like our figure, there is a "long tail.

What is and isn't MdDS ?

Various terms used for MdDS The MdDS academic community seem to be "splitters" and we have a proliferation of terms. The most recent is due to Dr. Cha (2022) who introduced the term "POV" for persistent oscillating vertigo, and then the term "nmPOV" for non-motion triggered POV. OK. We would call "POV" as a " rocker ", but why not "POV" I suppose. Extending the logic, "mPOV" would presumably equivalent to either MdDS or landsickness, and "mmPOV" for sporadic rocking. Hmmm. We will stick to the older terms. Motion sickness and Land-sickness is not MdDS. There are several variants of motion induced sickness that are not MdDS. This is very relevant because papers in the field that have "Mal de debarquement" in their title, are often studies of land-sickness. Sort of a bait/switch technique, probably because land-sickness is much easier to study, but using the name of MdDS makes it more publishable. A brief discussion of land sickness is here . Table 2 lists the features that, in our opinion , distinguish MdDS from land-sickness. Land-sickness (LDS) is common, and between 41% and 73% of persons disembarking from seagoing voyages experience a brief unsteadiness (Gordon, Spitzer et al. 1995; Cohen 1996; Gordon, Shupak et al. 2000). Common LDS typically persists for 2 days or less. Persons with LDS are also likely to have sea-sickness, (Gordon, Spitzer et al. 1995) while persons with MdDS generally are untroubled by sea-sickness. Males and females do not appear differ significantly in the incidence, intensity, or duration of land-sickness symptoms. (Cohen 1996). As mentioned above, LDS, is also termed "mal de debarquement" by many (e.g. Schepermann et al, 2019), presumably for convenience as LDS is much easier to study. Table 1 does not include reports or data concerning subjects who symptoms that last less than 1 month, i.e. potential land-sickness, except for the work of Cha, in whom the duration of patients with "classic" MdDS could not be determined due to study design(Cha, Brodsky et al. 2008). Dai et al (2017) also distinguish between "sea legs", and "MdDS", but some related publications from the same group mix them together. Van Ombergen, Rompaey, Maes, Heyning and Wuyts (2015), in a "systemic review", invented another nomenclature -- transient "MdD" symptoms < 48h, persistent MdDS (> 3 days to several years). "Transient MdD", using their nomenclature is equivalent to land-sickness as defined above. There is an undefined group for Van Ombergen et al (between 2-3 days). From 3 days to several years would overlap to some extent with the MdDS as we define here, and then from "several years" onward, no name. The "consensus" committe of the Barany society invented another nomenclature in 2020. "MdDS in evolution". OK. Lots of splitting going on here. MdDS also has some similarities to motion sickness (sea sickness, mal de mer). However, MdDS is again easily distinguished by the shorter duration of motion sickness and gender distribution. Persons with MdDS reliably have relief of symptoms when in motion, such as driving a car, but experience recurrence of rocking once motion has stopped (Hain et al. 1999; Cha et al. 2008). In motion sickness, many persons find driving very difficult. This is also often true for persons with vestibular disorders and migraine (Sharon and Hullar, 2014). MdDS also overlaps with a little studied group of patients called "rockers" , who develop similar symptoms to MdDS, without a preceding motion exposure. Another name for the same group is "non motion triggered MdDS"(Cha 2012) -- which is of course a contradiction in terms, but it presumably serves to widen the spectrum of "MdDS". Another term is "spontaneous MdDS" (Dai et al, 2017), again an odd term as there was no "Debarquement". The attitude in the literature seems to be that it is best just to tolerate these irrational nomenclatures. Occasionally these patients develop head or trunk rocking, which is called "titubation". In our clinical experience, the age, gender and pattern of medication responsiveness of this group are similar to those of MdDS. Although titubation is associated with cerebellar disturbance, evidence of cerebellar damage is generally not found in "rockers". Cohen et al (2015) also stated that their term for "rockers" is "spontaneous MdDS ". They found that these people were more difficult to treat with habituation but still "the cure rate was more than 50%". Hm. We have also encountered a few "rockers", who developed this symptom after a well defined CNS lesion, generally a small stroke. This is usually in the motion processing area of the brain.

What causes Mal de Debarquement ?

To start with, there are many unproven conjectures about the cause of MdDS. There is no "dominant" theory. If somebody tells you that MdDS is due to this or that, you should expect them to also say that this is just a theory, and that there are many other theories that could be true as well. It is the general opinion that MdDS is generally not caused by an injury to the ear or brain. The predominant opinion is that MdDS is a variant motion sickness. While this doesn't explain why MdDS seems to mainly affect women in their 40-60's it does seem to account for observations of naval personnel who have a similar land-sickness experience. We will start with the more reasonable theories. Of course, more than one could be true at the same time. Migraine: Many dizziness experts believe that MdDS is caused by a variant of migraine . Another idea is that there are many patients that meet the (subjective) criteria for both (Beh et al, 2021). We do think that migraine increases risk of MdDS. It also increases the risk of motion sickness. We have seen many patients who developed MdDS when exposed to motion around the time of their period (which is also a high risk time for migraine). This might explain why some cruises are tolerated without distress, and others not. Adaptation by down weighting vestibular: Another theory about the cause of MdDS it that is caused by inappropriately high weighting of somatosensory input for balance (Naichem et al, 2004). Your inner ear is giving you lots of information, so you increase your reliance on your feet. Still, as somatosensory information and vestibular information are both unreliable on a boat, this is a difficult explanation to follow. Adaptation to roll while rotating (cross-coupling) : Another conjecture is that MdDS is caused by adaptation to roll while rotating. In other words, if one is rocking side-side (roll), and also rotating the head, for long periods of time, one might develop an inappropriate cross-coupling between roll and rotation ( Dai et al, 2009; 2014). Our position on this idea is that it could explain brief (2 hour) symptoms after getting off of a boat, and also offers an explicit hypothesis that might be tested formally (i.e. people who do a lot of head rotation on a boat would be more likely to get this than people who sit quietly). However, overall we are dubious that this conjecture is correct. Why would women mainly develop inappropriate cross-coupling ? Why wouldn't people get rid of this by simply walking around with their eyes open ? Dai et al (2017) wrote "we postulate that the neurons on both sides of the brainstem oscillate with the activity flowing back and forth, at about 0.2 Hz to activate the body and legs into rocking and swaying at 0.2 Hz. The source of the 0.2 Hz drive is unknown, but it is likely to originate in the nodulus of the vestibulocerebellum, which exerts control over the velocity storage system (42–47). Such activity, which has been found in the cerebellar cortex of the nodulus in the rabbit (48), can be brief or can last for years. " We are not entirely sure what to make of this conjecture, as we would not know how to confirm or deny its truth. A similar hypothesis was developed by Cohen et al (2018) -- from the same lab -- see next section. Vestibular and cerebellar basis ? Cohen, Yakushin and Cho (2018) published a hypothesis article in an open access journal (Frontiers), entitled "The vestibular and cerebellar basis of the mal de debarquement syndrome". They discuss animal research done in their lab -- of course animals don't get MdDS. Monkeys exposed to "roll while rotating", but not pitch while rotating, developed inappropriate nystagmus when rolled, for 18 hours. Roughly the same amount of time as land-sickness in humans. They term 18 hours "long lasting". One persons long-lasting might be another's short lasting. They are jumping here from 18 hours to 1 month -- not our idea of long lasting and certainly not in the same territory as MdDS (30 days to forever). So these authors propose a model of land-sickness. One would expect that any adaptation phenomenon would not persist forever, as if you can adapt one way, you can also reverse the process, usually much quicker than you acquired it. This article goes on to discuss PAN, or periodic alternating nystagmus , which is a very slowly oscillating in appropriate eye movement that appears after brain damage (generally to the cerebellar nodulus). The authos of this page has previously been a coauthor of several papers on PAN. (Chiu et al, 2002; Furman et al, 1989) They (Cohen et al) suggest that the timing of the oscillation of PAN is similar to the timing of MdDS. We agree -- but it is even slower. Of course, the color of cheddar cheese is similar to the color of 24-caret gold, but one would not say that the two are otherwise similar. So the logical impact of this observation is limited. Of course, PAN is caused by a permanent process (damage to the cerebellar nodulus, often a tumor or stroke). It lasts forever, because the damage is there forever. Overall, the Cohen et al (2018) article is relevant to land-sickness. It contains a large number of questionable assertions about MdDS and very wide-ranging conjectures. The core assumptions of this article are, as they say in the legal field, "hear-say" (unverified information). We are not at all against making hypotheses, but it is best to keep clear about what is established by verifiable evidence and what is not.

Internal model theory and MdDS

A plausible mechanism for the development of MdDS is that it is due to formation of an inappropriate internal predictive model. We first proposed this idea in 2007 (Hain and Helminski, 2007). Internal models are sophisticated estimators that have been used to explain such difficult observations that one cannot "tickle" oneself (see the work of Wolpert (1995) and others). Examples of internal models are very easy to find in daily life -- suppose you pick up a suitcase, expecting it to be full, but it is empty ! Internal models are methods of dealing with events even before they happen (Blakemore, 1998) On a boat, one is faced with a difficult balancing problem, with components of rotation (pitch plane rotation -- about the axis between the ears), and linear movement (surge -- front-back movement of the boat). Both are somewhat predictable as the boat is large and it's interface between it and the ocean constrains it to low frequencies of movement. Lets take an example -- when the boat pitches (rotates) forward, there is a small amount of pushing the person backward accompanied by a tilt of the visual world as the angle between upright and the boat surface becomes more acute. To stay upright in response to pitch, a person should not activate their ankle muscles much as inertia tends to keep their body upright. Vision is accurate on the deck but inaccurate inside. Thus vision is unreliable. Although there is rotation around the ankle joint, and thus somatosensory input, there should be no "righting" response from the person because the body is upright in space. Visual responses are correct on deck and incorrect inside, and thus a "rule" cannot be made. The rule then for pitch rotation of the boat, one should ignore somatosensory information signaling rotation . Thus for pitch of the boat, a selective "down weighting" of somatosensory information, or both somatosensory and visual information according to context, would be a reasonable adaptation (or rule). For linear acceleration of the boat under the person, or "surge" as it is called in nautical contexts, inertia attempts to keep the person still in space, but due to shear force at the feet, the person becomes destabilized and rotates at the ankles. Then vision, vestibular and somatosensation senses are activated by the bodily rotation with respect to the boat, and an active response is needed to prevent a fall. Thus for surge of the boat, no relative sensory reweighting would be needed, although increased responses to all types of input might be helpful. How does the brain figure out which rule to apply ? We propose that people develop a predictive model of the boat motion, and use their prediction to select the rule to apply for boat motion (and avoid falling). Supporting this general supposition, Denise and Darlot (1993) suggested that the cerebellum was a predictor of neural responses, and implemented an internal model, that might be relevant to motion sickness. Normally, it seems likely that over a few days, people develop an internal model of periodic motion on the boat so that they predict and cancel out input (visual or somatosensory) that is phase-locked to pitch rotation, and enhance responses due to surge that is not. The internal model normally is disposed of once the person returns to terra firma, again over a period of hours to days. Persons with MdDS are unable to dispose of this internal model, which is only useful when they are exposed to periodic motion (such as when driving a car). We have encountered a few patients whose motion after-effects are specific to motion - -when they cross country ski, they have a motion after-effect of skiing, etc. In our view, this has to be an internal model problem. The internal model theory explains most of the features of MdDS. But it is just a theory.

Velocity storage theory of MdDS.

Maruta et al (from Mt. Sinai) stated in 2024 that "We postulate that mal de débarquement syndrome (MdDS) is a consequence of inappropriate sensory adaptation of velocity storage. " OK -- velocity storage is the central process that generally lengthens the signal from the inner ear to make it last longer and be close to the "perfect" signal that reflects actual head velocity in space. There are quite a few things that might be inappropriate -- gain, timing, the vector. These authors then go on to say that "Presently, we hypothesized that MdDS symptoms could alternatively be reduced by attenuating the velocity storage contribution in the central vestibular pathways." Translating again, this means reducing the central contribution to vestibular responses. In the previous literature, i.e. half a decade ago, this was called "habituation". The authors also call this habituation later on in their paper where they say "In this study, we investigated whether symptoms of MdDS could be improved by attenuating the velocity storage contribution in the central vestibular pathways by using a slightly intensified version of a vestibular habituation protocol that was previously developed for motion sickness treatment." Thes authors then say that "That is, a naturally long Tc or high g0 does not appear to be a risk factor for MdDS, nor does a naturally short Tc or low g0 appear to have a prophylactic effect.". In other words, a long Tc (meaning more velocity storage) was not found associated with MdDS. So in essence, they are saying that their study protocol helped MdDS, but it didn't seem to affect velocity storage. We think this study needs to be replicated.

Hormones and MdDS :

Because MdDS largely occurs in females, it may also have something to do with sex hormones, such as estrogen or progesterone.Cha et al (2018) reported that 34% of women they studied were in perimenopause during onset. In fact, we have noted a pattern that if one asks, it is often the case that the woman who develops MdDS was having a menstrual period while on the boat. Mucci et al (2018) reported that "From the data collected, it was evident that naturally cycling female respondents from the MT group were significantly more likely to report an aggravation of MdDS symptoms during menses and mid-cycle (p < 0.001). " This would suggest that MdDS is triggered by estrogen fluctuations, similarly to Migraine and motion sickness. Mucci et al (2019) also reported in a questionnaire study that symptoms were lower during pregnancy, making it similar to migraine (which commonly remits during pregnancy).. As MdDS is rare in men, perhaps testosterone is protective. This idea is unproven and there are anecdotes on both sides of the issue . At this writing (2020), there is quite a bit to be investigated about hormonal impact on MdDS.

Genetics: MdDS could also be genetic, related to two copies of the 'X' chromosome perhaps combined with other susceptibility factors. It is well known that there are motion sickness related genes. Out of more than 250 patients with MDDS, we have encountered only a single pair of identical twins who both developed MdDS (on different occasions).

Other conjectures about MdDS:

Anxiety, panic: MdDS seems unlikely to be a psychological disturbance. Although it is always difficult to exclude psychological problems for conditions diagnosed from symptoms alone, the male:female ratio would make this unlikely. Riley et al (2021) recently published a study of questionnaires administered to 55 study subjects. They wrote "Compared to population norms, the MdDS group scored significantly higher on the Patient Health Questionnaire-9 depression scale and the Generalized Anxiety Disorder 7 (GAD-7) anxiety scale, but only the GAD-7 correlated with symptom severity. " They concluded that "Psychological profiles of MdDS relate to disability but not to duration of illness." Moeller and Lempert (2007) suggested that MdDS is due to "deafferentation" or panic. We disagree with both of these ideas. Certainly though anxiety could make MdDS worse (as it makes most illnesses worse). There is some effort to attribute MdDS to a "functional" condition called PPPD (triple-PD). We think that the symptoms of MdDS, vestibular migraine , and PPPD overlap to such an extent that this is not a meaningful exercise. In other words, if you make up a list of symptoms for three names, and the symptoms overlap, there is little learned from using one acronym or another.

Changes in the brain... (yes this is a little vague)

Cha et al (2012) reported changes in brain connectivity in persons with MdDS. This study, however, was done in a powerful MRI scanner, which can cause temporary dizziness by itself. MdDS seems to be associated with changes metabolism in the brain, in circuits related to vision, vestibular processing and emotional reactions. It would be interesting to see how much of this is due to MdDS and how much is secondary to being dizzy. In 2015, in a study published in PLOS-1 ( open-access ), Cha and Chakrapani reported that " Individuals with MdDS show brain volume differences from healthy controls as well as duration of illness dependent volume changes in (a) visual-vestibular processing areas (IPL, SPL, V3, V5/MT), (b) default mode network structures (cerebellar IX, IPL, ACC), (c) salience network structures (ACC and IFG/AI) (d) somatosensory network structures (postcentral gyrus, MCC, anterior cerebellum, cerebellar lobule VIII), and (e) a structure within the central executive network (DLPFC). " 80% of the 29 subjects in this study were female, almost all were middle aged, and almost all had symptoms for more than 1 month; thus they met the conventional criteria for this MdDS. The authors point out that the brain volume differences might be due to compensatory processes rather than causes of symptoms. They also note that the results were presented with "uncorrected p-values and it can be argued that many of the voxels seen in the contrasts could be seen by chance". Mucci, Cha and others al (2018) reviewed the neuroimaging studies (almost all due to Dr. Cha's work) in a "perspective" article in an open access journal, and suggested that the the change in brain connectivity was one of the "main theories". In this article, it is stated that the hypothesis involves "a disorder of abnormal functional connectivity driven by a central neural oscillator that becomes entrained during periodic motion exposure". The "central oscillator ... can toggle between high and low states", and "MdDS may be a disorder of over-synchronization of brain networks". A similar hypothesis was offered by Mucci et al (2021). We find these ideas plausible but vague. It is true but rather "basic" to observe that an oscillating system likely involves a feedback loop. The separation between cause and effect -- i.e. is the change in brain function as the cause of MdDS or a consequence, still seems to be missing. There is also the difficulty that high field MRI's induce dizziness themselves. We are not convinced by the observation in this article that nystagmus (eye movement) was not observed in their own subjects, as we think the physics involved in MRI are pretty straightforward. Burlando et al (2022) wrote "We have formulated here a mathematical model of the vestibulo-cerebellar loop system and carried out a computational analysis based on a set of differential equations describing the interactions among the loop elements and containing Hill functions that model input-output firing rates relationships among neurons" OK, but what do we do with this? Jeon and others (2020) examined neuropsychiatric testing and functional imaging in 28 fisherman with landsickness (that they called t-MdDS). Thus they were not actually studying the subject of this page. There were multiple measures, and thus this was a "fishing expedition" type of study (pun intended -- generally you correct for multiple measures statistically). Individuals with land-sickness had better visuospatial memory, hypermetabolism in the occipital and prefrontal cortices, and hypometabolism in the vestibulocerebellum. We have no idea what to make of this. Of course, everything is connected to everything and which is the chicken and which is the egg ? Hopefully more studies will be done. Maruta, J. (2023) published a study of 3 rabbits subjected to 2 hours of "conditioning". He stated " After conditioning, simple side-to-side rolling induced an abnormal yaw ocular drift in the direction that opposed the nystagmus seen during conditioning, indicating a maladaptive change in spatial orientation. The impact of conditioning appeared to be partially retained even after 1 week and could be partially reversed or cumulated depending on the rotation direction in the subsequent conditioning." This research was done at Mt. Sinai hospital

There are some reports of MdDS following use or withdrawal from serotonergic medications, such as SSRI antidepressants . The connection here is that serotonin may inhibit glutamate, an excitatory transmitter in the vestibular nucleus (Smith and Darlington, 2010.). This idea also provides an explanation why serotonergic medications may help MdDS (see treatment section). Nonetheless, most MdDS patients did not withdraw from SSRIs.

The "Norwalk" virus is common on cruise ships, and perhaps this syndrome is somehow related to this virus. This seems a bit unlikely in that MdDS can follow motion exposure on a variety of vehicles other than boats, as well as the observation that Norwalk virus outbreaks such as in food borne epidemics on land, does not appear to be associated with MdDS symptomatology.

A recent hypothesis was offered that MdDS is related to an imbalance of CGRP . (Mucci et al, 2018). This is a bit hard to follow in as much as CGRP modulates vascular tone. Although there are now new drugs that inhibit CGRP for migraine headache ., these monoclonal antibody based drugs do not generally get into the brain. Our observation is that drugs generally dol not help MdDS, and at this writing, we don't think they are worth pursuing.

Internal jugular vein compression.

Dr. Cha (2022) has championed the hypothesis that internal jugular vein compression is an occasional cause of MdDS and rocking (which she calls nmPOV). She states "Compression is typically between the styloid process, the lateral process of the atlas (C1), and the posterior belly of the digastric muscle creating a jugular variant of Eagle's syndrome". Again quoting Dr. Cha, " A hypothesized mechanism is that increased pressure or dilation above a stenosed internal jugular vein could affect venous drainage or cause turbulent flow around the inner ear. Specifically, down- stream stenoses that affect pressure in the vein of the vestibular aqueduct that drains into the inferior petrosal sinus or higher pressure in the superior petrosal sinus (both drain into the sigmoid sinus that becomes the internal jugular vein) could lead to transmission of venous pulsation into the anterior semicircular canal are hypothesized to lead to rhythmic and at times pulsatile vertigo" Dr. Cha goes on to say regarding treatment "treating the underlying obstruction by a combination of focused physical therapy (1st rib mobilization, sternocleidomastoid and anterior scalene stretches, upper cervical spine alignment, ergonomic training), muscle blocks and Botox, and occasionally endovascular procedures and surgical decompression (styloidectomy with digastric muscle division, 1st rib resection, sternocleidomastoid myomectomy) has been helpful in reducing the intensity of oscillating vertigo as well as headache in patients in whom extracranial compressive etiology has been uncovered." (2022). Our difficulty here is that we find it hard to follow why taking a boat cruise should precipitate sensitivity to jugular pulsations. Perhaps though there are a few "rockers" who have sensitivity to jugular pulsations. We think best to keep an eye on this and look for evidence that these approaches help.

Theories of mechanism not related to the brain

It is a little hard to follow theories of mechanism for mal de debarquement, unrelated to motion. For example, theories related to anomalies in venous circulation in the brain, or associated by cervical spine instability-- how would this explain symptoms following boat travel ? This might apply to similar symptoms without a motion trigger. We suggest caution in pursuing these ideas..

What does the data say about mechanism ?

With respect to the hypothesis that MdDS is caused by reweighting of visual, vestibular or somatosensory input, the data so far is contradictory. Nachum and associates used posturography to study young males aged 18-22 with motion sickness and land-sickness (they considered land-sickness to be equivalent to mal de debarquement in their paper -- see table 2 above). They reported that these young men developed increased reliance on somatosensory input after motion exposure, and reduced weighting of vision and vestibular input (Nachum, Shupak et al. 2004). While the accuracy of visual input depends on whether one is inside the boat or on the deck, semicircular canal input is accurate on boats, and somatosensory input is intermittently accurate. Accordingly, it is difficult to understand a rationale for this adaptation. An intrinsic problem with this study is that the study group were young men with motion sickness and transient land-sickness, not middle aged women with the month-or-greater MdDS syndrome. Stoffregen et al (2013) also studied a different group than the usual MdDS sufferers -- 40 students of average age 20.68 years, oddly enough, without reporting their gender. Like Naichum et al, they defined MdDS to be land sickness, and thus they were studying something other than MdDS, but calling it MdDS. They defined "Low-MD" as symptoms for 30 minutes or less, and "High-MD" as symptoms for 120 minutes or more. Because this paper's definition of MdDS and subject population is so different than the clinical population in which the medical community diagnoses MdDS, they were studying land sickness but they were calling it MdDS, and there is little to be gained in considering their work further. It is interesting to note that Stoffregen's paper was published in PLOS, an open source journal . While the PLOS journals are very accessible, their review process is quite different than the traditional one that involves experts in the field. In other words, publications in PLOS carry less weight than publication in a standard journal where the material is reviewed by experts chosen by their knowledge of the topic. Well, at any rate, rather than the somatosensory weighting process suggested by Naichum, a more reasonable possibility is that individuals with MdDS may develop an increased reliance on visual and vestibular information (and thus decreased somatosensory weighting). This occurs in normal subjects who are exposed to situations where somatosensory feedback is distorted (Peterka, 2002), and would also be a reasonable adaptation to boat pitch. Either adaptation might result in inaccurate land sensorimotor integration. Nevertheless, neither of these adaptations explain the rocking sensation of MdDS or the characteristic improvement on driving a car. The most recent mechanistic proposition for MdDS is that of Dai and associates (2014; Cohen et al, 2018). They proposed that MdDS was caused by maladaptation of the vestibulo-ocular reflex (VOR) to roll of the head during rotation, and reported that a 5 day long protocol attempting to readapt the VOR resulted in “substantial recovery on average for approximately 1 year” of 17 of 24 subjects. While these results are encouraging, this theory does not explain why patients with MdDS are better while driving. Furthermore, it is difficult to see why ordinary movement through the environment should not recalibrate the VOR over a few days – the usual upper limit for the duration of land-sickness. At the time of this writing in 2021, the roll adaptation theory remains unproven, and the reason why the treatment is partially successful remains uncertain. Habituation is the obvious alternative theory to readaptation. A recent report suggests that this procedure is better than placebo, but the direction of the optokinetic stimulation does not matter (Mucci et al, 2018). This would be in favor of habituation over readaptation.

Diagnosis of Mal de Debarquement is completely based on subjective criteria.

MdDS calculator contains the current criteria of Dr. Cha and associates (see below) and you can see if you fit. In our opinion, the diagnosis of MdDS is made by a combination of the history (r ocking (within minutes) after prolonged exposure to a boat or other source of prolonged motion), improvement with driving or similar activities, a duration of at least 1 month, and exclusion of reasonable alternatives. A motion exposure of 2 hours is a bare minimum. The typical duration of exposure is a week. Tests to exclude BPPV , Meniere's disease (i.e. hearing tests ) and vestibular neuritis (ideally VHIT testing ), should be done and if there is a history of plane flight, perilymph fistula should also be considered. We do not think an MRI is always needed. Ombergen et al (2015) suggested similar diagnostic criteria: Chronic rocking dizziness that started after either passive motion or exposure to virtual reality (the virtual reality history is not supported in previous literature) Symptoms lasting for at least 1 month Normal inner ear function or unrelated abnormalities on ENG/VNG or audiological testing Normal structural brain imaging Symptoms not better accounted for by another diagnosis (this makes it a "wastebasket" syndrome , similar to vestibular migraine or PPPD ). Ombergen et al (2015) did not include improvement on driving in their criteria, but otherwise these seem quite reasonable. We think the improvement on driving should be included. Criteria 3-5 all break down to no other diagnosis. The Barany society has also offered their take on MdDS (2020). The lead author of this paper was Dr. Cha, and it included 8 other authors, who formed a "consensus" . Their criteria are: A. Non-spinning vertigo characterized by an oscillatory sensation present continuously or for most of the day B. Onset occurs within 48-hours after the end of exposure to passive motion C. Symptoms temporarily reduce with exposure to passive motion D. Symptoms continue for >48-hours D.0 in evolution: symptoms are ongoing but the observation period has been less than 1 month D.1 transient MdDS: symptoms resolve at or before 1 month and the observation period extends at least to the resolution point D.2 persistent MdDS: symptoms last for more than 1 month E. Symptoms not better accounted for by another disease or disorder. So breaking this down, we have rocking, rapid onset (we would say immediately, not within 48), improvement on driving (e.g. passive motion), duration of more than 1 month, and nothing else explains. We think improved from Ombergen, as it includes improvement with "passive motion", which could include driving. Note that these criteria do NOT include exposure to motion as do the Ombergen criteria, and for this reason, could include people who do not "debarque", or in other words, might have no motion exposure -- We think this is a mistake. We also like the Ombergen criteria that explicitly include imaging and inner ear "normal" function. We would have preferred this in the Barany society criteria - -which we think are too inclusive. These criteria are embedded in the MdDS calculator which will allow you to find out if the Barany society criteria categorizes you as having MdDS. Of course what really matters is not how you define these things, but whether you can make the person better. Our ideas about treatment are found here. As a bottom line about treatment, anyone is free to make up crtieria for symptom based disorders, and we have several to choose from- -we think the most recent committee's criteria (Cha et al, 2020) is too inclusive. We think the Omsbergen 2015 criteria are currently the best.

What to look for:

A typical MdDS patient is a woman between 40-60 years of age, who has gone on a cruise, and who is now rocking. Recently, the criterion has been expanded to require getting better on driving. This feature is extremely common in MdDS, but rare (but not at all unheard of) in inner ear disorders or Migraine. (Sharon and Hullar, 2014) What about Atypical MdDS ? Considering the demographics, atypical features might be age (> 65), gender (male rather than female), lack of a provoking motion stimulus. If we were to combine these with "improvement with driving", this individual would be so aytpical, that one would think it unlikely that they had the same condition as the typical patients. Still, they might be considered MdDS by the subjective criteria suggested by the "Consensus" committee of the Barany society.

Testing in Mal de debarquement:

Cohen et al (2015) state that "although vestibular testing can be of use, in general, MRIs, VEMPS, auditory evoked potentials and multiple blood tests really have nothing to offer diagnostically". That being said, MRI's are commonly done. Note that the Ombergen criteria requires "structural imaging", which might include an MRI or CT scan of the brain. As the Barany society "consensus criteria" includes the criterian E. Symptoms not better accounted for by another disease or disorder, we think this means that one should assess for the more usual suspects such as vestibular migraine, Meniere's, SCD, and vestibular neuritis. Usually the basics here would include (at least) an audiogram, oVEMP, vHIT, and ideally a rotatory chair (see below). Gibbs et al (2010), determined that the Romberg test is not sensitive to "sea legs" (land sickness). This is very puzzling given that a prominent complaint is imbalance. It is also puzzling in that our treatment results which includes posturography suggests improvement in balance with reduction of rocking. Perhaps the Romberg test variant used by Gibbs et al (2010) was just too easy. Generally one can always find a Romberg variant that is difficult for someone. In our practice, we get the following tests, in persons who are not "classic" (i.e. "rockers") -- i.e. not improved by driving and not on a cruise, or an outlyer on age/gender expectations -- see table 1: Audiogram and sweep OAE (expect normal, abnormal suggests other disorders involving injury to the ear) Rotatory chair test. This is usually shows normal vestibular responses. oVEMP tes t -- looking for SCD (about 1% population) and utricular loss The VHIT test is sometimes used instead of the rotatory chair, but it usually provides less information. The big advantage to the VHIT is that it is unlikely to be associated with motion sickness and also that it is a very good test for vestibular neuritis. . We have not found that MdDS patients exhibit abnormally large vestibular gains or abnormally long time constants on rotatory chair tests. They generally test normally on the rotatory chair, unless they are taking benzodiazepines such as clonazepam or diazepam (which decrease VOR gain and increase VOR time constants). Perhaps a test can be developed involving a balance measure (such as posturography), and an external source of passive motion.

Treatment for Mal de Debarquement

We have moved this page elsewhere, as this page was getting too big. See the MdDS page in the treatment section of this site . A review article about treatment can be found in Frontiers online (Canceri et al, 2018), and this might be a good place to start. If you are just looking for the OKN stimulator, it is here .

Prevention of MdDS

Medications taken prior and during boat travel might prevent development of MdDS.

• According to Cha and others (2009), having migraine increases the probability of recurrent MdDS. It would seem logical that medications that prevent migraine might also modulate MdDS. We are presently looking at this situation in patients taking venlafaxine. See comments above regarding mechanism and serotonin.
• Anecdotal evidence suggests that while meclizine and scopolamine are ineffective, people can prevent MdDS by taking very small amounts of Valium, klonopin, or Ativan (lorazepam) prior to getting on the boat or airplane. The author has used this strategy in his patients many times with excellent results. The usual dose is 0.5 mg. of klonopin or lorazepam, at start of trip and every 8 hours. For cruises, once every 12 hours is sufficient. Again, this strategy has not been tested by a research study and a trial, perhaps controlled with one of the medications known not to prevent MdDS might be helpful. Nevertheless, medications which suppress the inner ear or block adaptation to inner ear signals might be useful.
• Some have suggested to us that exercises done prior to getting back on the boat might prevent MdDS. Given our present theory of mechanism, we would find this idea very implausible. We do not know of any examples of this working or not working.

Our suggestions for physical activity:

• Avoidance of periodic motion is probably helpful (Teitelbaum, 2002). If you get dizzy from riding on boats, don't do it !
• We also tentatively think that large amounts of driving would be a bad idea. Internal model theory would suggest that it would be better to be a passenger than a driver (to prevent MdDS), but again, this is not established.

Going on another boat and related activities:

• Well -- if you must go on another cruise for some reason, we advise taking small amounts of klonopin during the cruise (see "prevention" above).
• Situations where there is a direct confrontation between the rocking sensation of MdDS and a very clear and normal sensorium seem reasonable. In other words, walking outside (on a calm day), on a firm surface, where you can see the horizon, might be helpful.
• Doing things that makes the symptoms better (such as driving a car for long periods), might (in theory anyway) prolong the duration of MdDS.

Research is needed !

MdDS is not very well studied. As of 2019, a search of Pubmed for titles including "mal de debarquement" in the title turned up only about 56 papers. Considering that many other obscure conditions have 1000's of papers written about them, this means that MdDS has been generally ignored. Ongoing research projects regarding MdDS include several by Dr. Cha, several by Dr. Mucci, some in Belgium (Van Ombergen), and in Ohio (Dr Clark). Dr. Brian Clark, from Ohio University,  is the lead investigator in a pilot study,  Development of a Tele-medicine Approach for the Treatment of MdDS.  This effort includes investigators from Ohio University, Ohio State University, and the Icahn School of Medicine at Mount Sinai in NYC. We do not know of any treatment projects involving medication. Questions that we think should be asked are: Do benzodiazepines taken during motion prevent development of MdDS ? How about other drugs that affect GABA ? Do sex hormones (such as estrogen) or blockers of sex hormones (such as used after breast cancer) affect MdDS ? -- There has been some work on this (see references ) Is there a correlations with particular medication intake (e.g. for migraine, seizures, psychiatric conditions) and prevalence of MdDS ? The following are some recent links. A survey of patients with MdDS has been offered by an Australian group. https://www.surveymonkey.com/r/MdDS_Survey_Browne link.springer.com/article/10.1007%2Fs00415-017-8725-3: A paper and review article related to a survey of MdDs is here: //uwsssap.co1.qualtrics.com/jfe/form/SV_cu811naTKs6CHd3: A study regarding pregnancy and MdDS from Western Sydney

Related Links:

There is a MdDS foundation, which maintains it's own website and encompasses a quite active group of volunteers. The author of this page, Dr. Hain, is loosely associated -- I sometimes provide some advice to this group. There are also several other groups world-wide. There is also a facebook page concerning MdDS with 1000's of members.

• //www.mddsfoundation.org/research-studies-seek-to-understand-mdds/surveys-results/: Surveys that the MdDS foundation would like you to take
• //www.findacure.org.uk/mdds-awareness-month/">MdDSs awareness month (6/2016)
• https://www.actionformdds.org.uk/": Action for MdDS UK
• mddsaustralia.org
• https://vestibular.org/news/02-16-2016/mal-de-debarquement-survey-results -- Vestibular Disorders association (VEDA)

Acknowledgement:

• We thank Dr. Bernard Cohen for providing us with information regarding Darwin's first description of MdDS
• We thank Dr. M. Cherchi for providing us with information about Jack London and the "SeaWolf" description of land sickness.
• We thank P. Moyer for forwarding to us links to relevant literature.

Click here to return to index

References on Mal de Debarquement Syndrome

MdDS Foundation

MdDS Makes You Feel Like You’re Still on the Boat

Land sickness after cruise or boating.

You’re standing in a small boat tied to a dock, waves moving you back and forth, up and down, and side to side. Now, imagine that you feel this way all the time, even without the boat. You can’t concentrate. Your head hurts. You’ve never felt so fatigued in your life. You don’t know what’s wrong and you need help.

Your diagnostic tests are all returning as normal. After several months of symptoms, you start to wish that you had a brain tumor just to have an explanation. Nobody, neither you nor the physician, made the connection that your symptoms started after you returned from that last vacation during which you were in a boat all day. Welcome to the world of someone with Mal de Débarquement Syndrome.

What is Mal de Débarquement Syndrome?

As a neurologist and scientist who studies Mal de Débarquement Syndrome (MdDS), I have heard countless stories just like this. Today, MdDS is rarely recognized immediately and is often misdiagnosed as Ménière’s disease, vestibular migraine, motion sickness, or even as a form of psychosomatic illness.

MdDS is literally translated as the “sickness of disembarkment.” It is a disorder of rocking vertigo and imbalance that starts after a period of motion exposure, such as going on a cruise, flying, or even a long car ride. Unlike short-lived land-sickness, MdDS can persist for months or years.

MdDS is a brain disorder

The MdDS phenomenon is the natural result of the human brain adapting to environmental motion and is thus the quintessential neurological disorder. How and why the brain gets “stuck” in this entrained state is a question that researchers, including those in my lab, are trying to answer. There is  evidence  for brain connectivity to spatial processing areas as being altered in MdDS, some of which can be reversed with treatment. This island of insight, however, is surrounded by a sea of unanswered questions that we hope to address with continued research.

For now, what we know is that if MdDS symptoms do not resolve within several months, the chances of remission get pretty slim. Medications such as benzodiazepines and some types of antidepressants can ease the symptoms, but the development of persistent MdDS often leads to other problems such as difficulties with attention, emotional control, pain modulation, and tolerance to sensory stimuli like light and sound.

Patients with MdDS have spent thousands of dollars on vitamins, diets, hyperbaric oxygen, induced altitude sickness, magnetic bracelets, chelation therapy, and antibiotics. Some have even had inner ear surgery to no avail. If you can name it, a desperate person with MdDS has likely tried it.

What physicians need to know

What physicians need to know to distinguish MdDS from other disorders of vertigo or dizziness is that affected individuals feel  less  of this internal motion when they are  actually  in motion. Getting into a car or back on a boat is a temporary reprieve from the otherwise constant symptoms. They remain symptomatic when they are still, such as standing or even lying down. In other words, they are never quite able to rest.

It turns out that this under-recognized and understudied disorder affects thousands of people every year, typically middle-aged women, though also a fair number of men. Research into MdDS has shown that factors related to the aging brain, hormonal changes, and stress contribute to the vulnerability of triggering an episode. One could take 15 cruises in a lifetime and have no problems, but the 16 th  one could trigger persistent MdDS.

I once experienced a brief episode of MdDS myself after a flight from Boston to Los Angeles. After a week, it dawned on me that if the symptoms continued, my medical career would be over. I was lucky that the symptoms eventually abated, but the experience showed me that MdDS could happen to anyone, even otherwise healthy, high-functioning, experienced travelers. Indeed, as more and more people travel for work or leisure in an increasingly interconnected world, recognition of travel related disorders like MdDS will be all the more critical.

Research funding and awareness of how everyday environmental stimuli, such as oscillating motion, can affect human health are needed in order to prevent disability from disorders like MdDS. We need greater insights into how motion disorders are related to brain dysfunction and especially in how to treat them.

Physicians must also play a central role in recognizing this disorder, providing counseling, avoiding unnecessary tests, and making appropriate referrals. Today, many patients go to their physicians with MdDS and get discouraged or derailed. These patients will testify that illnesses without a physical marker are some of the most devastating of human disorders. We need to affirm them as much as we do our patients with heart disease or broken bones.

Though we still need to develop more effective therapies for MdDS, we can at least lay a foundation for recovery by first giving the patients an identity.

August 16, 2017

Helpful Links

Symptoms of mal de debarquement syndrome, getting diagnosed with mal de debarquement syndrome.

• The biological basis of MdDS is real. Studies have given us an understanding of the neural basis of MdDS, and guided the development of different forms of non-invasive brain stimulation therapies. – Yoon-Hee Cha, MD

40 comments

I had a bout of Mdds type symptoms for about 6 weeks. I ended up going to see a massage therapist and she did acupressure into my head and stimulated the ocular points. My eyes started twitching immediately. Wishing about three sessions off the treatment, my symptoms subsided and left me completely. I did get them again mildly for about three days after dealing with liver issues. I’m healed. Thanking God. I am going on another cruise tomorrow and this time taking pressure bands on my wrists and diazepam and very low dose Xanax every 12 hours. Will report back and let you know.

My daughter had these symptoms after surgery about 8 years ago. She had extreme vertigo and could barely function. She went to a highly respected neurologist in Atlanta, who prescribed her topomax and told her to play tennis for the back and forth, and side to side movements.

He said she had a type of vertigo migraine (must have been triggered by her surgery). She gradually got better, and didn’t need either of the above after a year and a half. She also found out that she had to stop drinking caffeine, because that started being a trigger of the same symptoms. She is also prone to landsickness for a few days after a cruise, but it has never affected her like the surgery. Maybe there is a connection? The symptoms were the same.

I developed a constant swaying sensation after working as a flight nurse in 2016 at the age of 46. After training for months on the ground, I took my first flying mission and upon landing noticed that I was swaying left and right constantly (in my head ). I noticed the sensation went away when I was flying or driving. I denied it for a while out of fear of losing my hard earned job but after a while I had to seek treatment. The second md I saw actually had heard of MdDs but offered no treatment. He referred me to a neurologist who was so rude. “You must have a brain tumor “ is how he joked! He referred me to a vestibular therapist who must have googled the diagnosis. But she definitely tried to help. Unfortunately I don’t think the vestibular therapy did a thing. I was given Prozac by my pcp mainly because I became really depressed. The constant movement in my head just made life difficult. I had that sensation constantly for about 9 months then it slowly went away. During that time I lost my job and gained 25 lbs. It was really hard but thankfully it went away and then I got my life back… sort of. Well sad to say but, two weeks ago, the swaying sensation came back. It’s exactly the same. Goes away when riding in a car. Constant swaying in my head. I don’t know what to do. I don’t know if I can take another multi month episode of this. I guess I’ll go see another doctor ( who won’t know what what to do:(

Susan, be sure to ask for doctor recommendations in MdDS Friends , our private support group on Facebook. If you would like educational brochures or quick reference cards on MdDS to hand out to the medical professionals you saw or work with, they are complimentary by request to [email protected] .

Hi, I have just moved to new office. Lately I’ve been experienced a ‘ like a floating or on a boat’ situation. It’s not really a vertigo. Sometimes I felt hot and sweat a bit. I’m turning 50 this year. I’m taking blood pressure medication. I don’t know why I have this problem. Am I having MDDS? Or should I make a blood test to see what’s wrong with my body? Thank you.

The MdDS Foundation does not diagnose or offer medical advice. If you have any specific questions about any medical matter you should consult your doctor or other professional healthcare provider. If you suspect that you have Mal de Débarquement Syndrome, please consult with your doctor to develop a plan of action. A brief list of health care practitioners who may be familiar with MdDS is available on the Living With MdDS page of this website. We hope you feel better soon.

Hello, I am a 64 year old woman, constantly researching to try to establish ‘WHAT THE HECK IS WRONG WITH ME’. 6 years ago I had quite an horrendous horse riding accident, sustaining a compound left ankle (tib and fib) severe whiplash, a fracture to my back at T11 (which got overlooked for 20 months) and bruising. My hospital stay was 14 days, after 3 operations on my ankle to fix it. I did appear to make a reasonable recovery but had to have metal implants removed due to metal sensitivity. After this operation I developed a type of unusual feeling! I explained to my doctor and numerous Neurologists and specialists ” it feels like I am in a boat rocking, swaying and bobbing about”! That is 4 years ago, I am still seeing Specialists (even got referred to a Psychiatrist) with these never ending symptoms! My life is nothing like it used to be, I was very bubbly, energetic, confident,out-going. I exercised regularly, had a good social life etc., NOW I have no independence! I can not get about our home without holding onto the doors/walls etc., I do not go out anywhere without my husband (in a wheelchair) as my legs literally feel wobbly (but when tested by doctors, they say my muscle strength is good). My vision is 20/20 according to my eye specialist BUT he is baffled that I have a downbeat nystagmus in my left eye and fixation in my right (which is horrendous) most of the time I have double vision. Especially when my eyes move from centre position. I can not do housework or anything much anymore and all the doctors I see cannot come up with anything! Your blog has made me realise I have practically all the symptoms of MdDS (at least it is a relief to find something that fits my symptoms!) I have drove myself mad with worry/anxiety thinking it was life threatening! Please can you send me some literature on this subject. Thank you E. Nash

Have any patients been treated with ECT I know it is an extreme way to go but perhaps it could help

Edith, this is the perfect type of question to ask in our support groups, where members discuss the therapies they have tried. As a member, you can search by topic or keyword, such as ECT, and of course you may ask questions. Our members are from almost 60 countries and can offer much advice and support. Learn more on our Find Support page.

Thank you Dr. Cha. I’ve found that it isn’t quite so heavy a burden when other people know what I’m going through. One thing I haven’t heard anyone describe is to stand up and close your eyes. If I’m not holding on to something stable I will fall. I think it is important to share all of our symptoms. Perhaps someone in the future may benefit from it.

Two days ago, an ENT specialist told me he thinks I have MsDS. I was hospitalized briefly about a year ago after a fall at home, where they ran more tests than I can remember, all negative.

The symptoms abated after a while and I forgot about it. About six months ago the symptoms returned and have been constant for about the last three months. A couple of weeks ago, I had a head MRI that was negative, just like every other test.

I’m exhausted, I feel sick all of the time, and I can’t focus on my work. It’s driven me to nagging thoughts of suicide. I had no idea that MsDS was even a thing until two days ago – I thought I was crazy and it was all in my head.

I have an appointment with a neurologist next month and I sincerely hope that they find something else.

B, MdDS can be episodic and we hope you are able to again achieve remission. In the meanwhile, please consider joining one of our online support groups. There are many people (men and women, all ages) that truly understand the exhaustion, inability to focus, and other feelings you are experiencing. https://mddsfoundation.org/support/

I believe I have been battling this condition for close to 19 years (I am 47). It began after an extremely turbulent flight and is only relieved when driving or riding in a car. I stopped takin cytolopram 3 months ago, which provided some relief, and am now overwhelmed by the moving sensation in my heavy head, head and neck aches, and mild depression. I moved to AZ 6 years ago and am still yet to find someone who understands what MdDS is. I was referred to what I was told was an extremely reputable neurologist. I waited the usual 2 months for my appt and prepared a detailed description of all my symptoms and every test I’ve had done over time. Two days ago I arrived at his office excited and left deflated The Dr said he read what I sent but it was very easy to tell he did not. I began to mention MdDS and was cut off and told it was the same as vertigo. I then had to point him to the paragraph on my recent VNG test result that explained my significant nystagmus which he said I did not have.. I was thankful I brought my wife for the first time who witnessed this debacle and complete lack of care and understanding I’ve explained to her for years. Can anyone direct me to someone in AZ? I cannot express enough how any advice is appreciated. I’ll take 50% improvement just to be the husband and father I used to be and stop having to hide this from everyone.

GW, please send us the name and address of the neurologist and we will mail a Letter for Professionals and educational brochures to his practice. Email the contact information to [email protected] . Please include a request for the letter and brochure in the body of the message, as the mailbox is checked by various board directors. Thank you.

I have had this syndrome for 10 years. It just happened. It was not from a plane or a boat. Your experience with the neurologist is what happened to me several times. I’m sure their lack of interest is a sign of their frustration but it’s still another action that causes us to have more depression. I had one neurologist tell me he had never heard of MdDS, and yet when I looked at my paperwork when I left the office MdDS was the diagnosis he had written down. That was extremely depressing. We go in with such hopes that someone will know what to do to help us and we leave without hope. I have been seeing my primary physician for 10 years, and she said she has never seen this disorder before. I am lucky in that I do have hours that the rocking and bobbing will go away.

I am a 78 year old male and have had MdDS for 9 years. Ditto to just about everything that has been said except that I have never been without it. I have stumbled and fallen sometimes, but I haven’t seen that mentioned.

I was recently diagnosed by a neurologist with MDDS. I think I started having sometimes after a boat ride, but I can’t believe that one boat ride caused my dizziness. I have been an avid boater since I was eight years old and have never experienced any dizziness until the past year. I am not 100% certain that I actually have MDDS, while I experience a rocking sensation I do not have serious balance issues and when I am sitting or lying down I feel great with no dizziness at all. I am only dizzy when I am moving. It feels like I am on a boat dock when I walk and move around, however sometimes I experience no dizziness at all when I am moving. If I do have MDDS I think I have a mild case. I hope it doesn’t get worse in years to come .

If your symptoms worsen or you just need support, please consider joining one of our online support groups. https://mddsfoundation.org/support/

Kathleen. After reading different descriptions from different people I feel that there are different degrees of this syndrome. I too feel more balanced when I am lying down and I do have days that I am free from the moving motions. None of these feelings would I ever describe as dizziness. I just feel like I’m not balanced. Each conversation with my physicians starts out with how is your dizziness. I say, I’m not dizzy , I am rocking and swaying and bobbing. Some days are worse than others. Some days are better than the others.

Yes you are correct! I definitely feel rocking and swaying kind of like I’m walking on a boat dock. Thanks for the clarification. I will not use the word dizziness to describe my symptoms.

Onset following an activity which many of us have done prior, whether taking a flight, a boat ride, a long car ride, etc., without consequence is part of the MdDS phenomena.

You have some similarities with Cathy H., who was recently interviewed by the Washington Post. She is a lifelong sailor whose MdDS onset followed 2 days on a boat. You can find a link to her story and many more on our Media page . Not mentioned in the story, for lack of a better word Cathy also used the term “dizzy,” which contributed to her being misdiagnosed.

Semantics aside, we are glad to hear that your neurologist is able to diagnose MdDS. We hope that you get to a point of no “dizziness” at all very soon.

I was very lucky that the second neurologist diagnosed me. The difference was she really listened!! I was the first patient she had seen with MDDS.

Darlene, is your doctor listed in our Find A Doctor tool? If not, please send their contact information to [email protected] so that we may reach out to them about inclusion. Thank you.

Do any males ever respond /reply?

Right here.

Gordon, Males tend to be more active in our support groups than on this blog. To learn more about our online but private groups, https://mddsfoundation.org/support/

I was diagnosed with Mal de Debarquement Syndrome in 2008 after a stressful trip to Alaska. I cope with this challenging condition by adhering to a regiment of medication (Clonazepam [doasage redacted] a day and [redacted] sertraline a day). I try to control my environment to elevate ( sic ) triggers that intensify this disorder. I also try to remain active by walking outside and doing yoga. I was in physical therapy for 5 years and this helped me get to a place where I could do yoga. I had brief episodes of MdDS in my late 20s and early 30s on more than one occasion after boat trips. I was prescribed a low dose of valium by ENT physicians and symptoms would disappear after a few weeks but the Dr’s never used the term Mal de Debarquement Syndrome. This condition has changed my live forever. I have suffered silently for many years for fear of judgement from family, friends, and my employer. Even my mother, who was a nurse, makes snide passive aggressive comments about my dizziness, and my supervisor often makes comments that make me feel awkward about this sickness. I guess I can understand somewhat, I look normal and I try my best to act normal and push through my life. However, what is going on inside my head is not normal and everyday is a challenge for me. This is what I know. It is imperative to have 2 legs in order to deal with this condition. I cannot imagine balance without both of my legs. I know stress and anxiety makes it worse. Not getting rest makes is unbearable. Loud noise, bright lights, patterned carpet, big box stores, malls, household chores such as ironing and vacuuming aggravate my condition. I work in Excel and that can heighten my symptoms. I feel it is getting more difficult for me to organize my mind and to articulate my thoughts and feelings through speech. I feel like my brain is getting eaten up by a cancer and everything I do takes twice as long as it used too. Mal de Debarquement Syndrome is an overlooked disability and I struggle with it everyday. It is exhausting but I will never give up. I have hope and I am a fighter.

I got off my 7 day cruise to Alaska in 2004 and have never quit rocking and bobbing as you say. The first night I couldn’t sit in a chair, I felt The chair was tilted and I was sliding off and felt I had to try to hang on. I visited all local Dr’s. and they referred me to dizzy and balance clinics which helped a little but still felt like I was walking on a trampoline. Finally saw an ear specialist and he said mal debarquement and sent me to another balance clinic. I gave up. I take no meds for it. I detest grocery stores and trains. Sensitive eyes are a problem. I try to appear normal but never feel that way due to being so careful not to fall. Your articles validate all I live through each day. Thank you

Had a vertigo 1st time 5 yrs. ago. Got better through therapy. Then had another bout about 6 months ago. Am back to my therapy exercises. Helps a little. But I am beginning to realize I will propably deal with this for the rest of my life. Ugh! I’m told it is vestibular vertigo. That just means theu don’t know what is causing it.

I’ve gotten into an unbalanced state after being on top of tall skyscrapers like the John Hancock tower in Chicago. It also happens when standing on a stable unmoving pier, but seeing the waves of water makes my brain feel like I’m in motion. Small boats, vehicles and planes don’t seem to cause a problem, it’s the large vessels like giant ferries and cruise ships.

Thank you, Dr. Cha, for your dedication and providing your perspective. It means so much to see MdDS information in print.

I’m in my 60s and have had MdDS for half of my life now. It came on immediately after a rough cruise. Symptoms continued for approximately a month then began to deminish. Little did I know my life would never be the same. Symptoms returned and I spent years searching for answers, but to no avail. All labs OK, MRI normal, etc. (Did have one doctor suggest I may just want to dye my hair blond, though. Not funny!) So I eventually stopped talking about how I felt. Tried to create diversions and live a normal life. Not always successful, but fell back on common sense approaches to living with this invisible illness. It was not until the Internet was available did I have a clue MdDS existed. I believe it was a link to your early research I discovered. As soon as I read that patients usually felt better while in motion, I knew we shared the same diagnosis. It was then that I finally felt some validation. So, thank you again, Dr. Cha! People suffering from MdDS don’t necessarily have to go through the mental humiliation brought on by a doubting medical community.

After reading this I feel more disheartened and just time to give up.

This disorder is unbearable and after over 3 years of rocking and falling what is the point?

This life stealing beast should just kill us quickly. That would be compassion.

We are sorry you feel this way. MdDS is a beast. We hope you find some support and compassion. The Foundation and the support groups are always here for you.

My heart goes out to all those people with this disorder. I have been suffering with it since 1977, 40 years, and was only diagnosed with it about 12 years ago, after numerous visits to doctors, none of which were able to find anything wrong. My symptoms began after an extremely rough flight in an air force transport aircraft and re-occurred periodically until another motion incident, a wild train ride that set in motion ( no pun intended ) the continuing daily saga that we MdDS rockers know. It is heartening to see some recognition of this rare malady and finally research funding to try to solve the puzzle of how it works. I am glad to see the improved website and will be watching for any new developments. Good health to all. I hope all your journeys are smooth and tranquil.

When my symptoms came on – I DID NOT travel – I was dealing with a series of stress causing events ( I believe). I had had a few beers the night before and thought it was a weird hangover reaction – but it never went away…over 2 and 1/2 yrs later. Not letting it stop me – and meditation have helped me to deal with it..I don’t drink anymore but that hasn’t affected it one way or another. just paying attention and taking care of my self, knowing my limits (which I had to find out) Love swimming – no physical resistance, my body get a rest..

I got rid of my MDdS after eight months. I began a treatment with paroxetine for six months. Then changed to fluoxetine and i am on it. It works for me. Sometimes i need a very little dose of alprazolam. But fluoxetine ( prozac) helps a lot. I have had this episodes four times. All during more than three months. Always after a cruise

Hi Lola, many thanks, this is good to know.

Could you please let me know which kind of antidepressants can be most helpful?

Yes. Finally, someone has pinpoint what has been happening with me! I kept telling the nineteen doctors I have seen about my problem for the past four years and only a one really understood me. Now here it is! Thank you Dr. Cha!

“On average, it takes an MdDS patient a staggering 20 visits to a healthcare provider for a proper diagnosis.” This is excerpted from “ Scientists seek answers about Mal de Debarquement Syndrome, a rare condition that evokes a constant feeling of motion ” which discusses some of the work of MdDS researcher, Dr. Brian Clark. Please read and share.

Comments are closed.

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An uncommon cause of headache and dizziness after cruise travel: case report of Mal De Debarquement syndrome

Mal de Debarquement syndrome (MdDS), also known as disembarkment syndrome, is a benign neurological condition characterized by a feeling of rocking, bobbing, or swaying, usually presenting after an individual has been exposed to passive motion as from being on a cruise, long drive, turbulent air travel, or train. Clinical awareness about this condition is limited, as is research; thus, many patients go undiagnosed. In this case report, the authors describe a case of a severe headache as a major presenting symptom of MdDS in a 46-year-old woman who eventually attained full resolution of symptoms. This report aims to highlight this unique presentation and make practitioners more aware of the cardinal clinical features, to assist in prompt diagnosis of this disorder.

Mal de Debarquement syndrome (MdDS) is a benign neurological condition characterized by a feeling of rocking, bobbing, or swaying that usually presents after an individual has been exposed to prolonged passive motion. This association between prolonged motion or travel and subsequent MdDS symptom onset has been well documented [ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ]. Normally, individuals experience a short-lived sensation of movement after cessation of the inciting events, which could be a cruise, long drive, air travel, or train ride; the sensation of movement usually resolves within 24 h [ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ]. For a subset of individuals, mostly women (>90%, according to Mucci et al.’s retrospective study [ 5 ]), this illusion of movement persists and may last for weeks, months, or years [ 6 ].

Growth in scientific interest has led to a somewhat better understanding of the biological basis of the condition. However, the cost to obtain a diagnosis of MdDS remains disproportionately high (approximately $3,000 USD per patient) and requires a large number of healthcare practitioner visits, with only 2/3 of patients receiving a diagnosis after more than three months [ 7 ]. These factors clearly support the need for increased awareness about MdDS amongst practitioners to help reduce diagnostic delay and costs; we hope this case report will contribute to that increased awareness.

Report of case

Consent was acquired from this patient to retrospectively review her case and clinical management protocols.

A previously healthy 46-year-old Black woman presented to her primary care physician with chief complaints of headache and dizziness. Her past medical history was notable for irritable bowel syndrome associated with constipation, but those concerns had been adequately managed without recent flares. Her surgical history was positive for a laparoscopic sleeve gastrectomy and a hysterectomy. The patient’s family history was notable for diabetes and cardiac disease but negative for any neurological disorders. The patient, her husband, and their two children had recently been on a weeklong cruise to the Caribbean. She reported onset of headache and dizziness within hours of disembarking the cruise ship. The patient described the headache as severe, left-sided, throbbing in nature, and constant throughout the day. She described her dizziness as bobbing and swaying in nature. The patient also reported associated symptoms of blurry vision, severe fatigue, and insomnia, but she denied tinnitus, tingling, numbness, fever, vomiting, or diarrhea.

On physical exam, the patient was in no acute distress. Her vital signs were normal. She had a horizontal nystagmus; however, her vision was intact without eye redness or eye drainage. Her tympanic membranes were clear bilaterally, and she presented without any gross auditory deficits. The patient’s cardiopulmonary examination was unremarkable and her physical exam was grossly normal otherwise. Her reflexes were normal and motor examination demonstrated no focal weakness. The patient was prescribed meclizine for vertigo and instructed to return if symptoms persisted while blood work was pending.

Two weeks later, she returned to her primary care physician’s office reporting persistence of her symptoms. The patient was referred to a local emergency department where a head computed tomography scan, electrocardiogram, and chest radiograph were found to be normal. Subsequently, the patient was transferred to a tertiary medical emergency department for further neurological evaluation, where she was eventually admitted. Upon arrival, she was managed proactively with intravenous prochlorperazine, ketorolac, and diphenhydramine. She also received intravenous magnesium sulfate, prednisone, and diazepam, which provided some symptomatic relief.

The neurology department was consulted; neurological evaluation revealed normal findings on examination of cranial nerves II–XII, motor strength, and muscle stretch reflexes. The patient demonstrated normal stride length, arm swing, and width. The patient was able to walk on her toes and heels, but had some difficulties with tandem gait. Romberg test was negative.

In the setting of largely normal lab tests, imaging, and the patient’s unique history as well as negative evaluation for other diagnostic considerations, she was diagnosed with MdDS. She was then initiated on a two-week course of 0.5 mg clonazepam twice per day as needed. The patient noted taking her prescription regularly, and at follow up 2.5-weeks later, her symptoms had resolved.

The patient described here reported the cardinal symptoms of MdDS, which include a constant sensation of rocking, swaying, bobbing, and bouncing when walking or when lying down, with resolution of her symptoms when back in motion, as during a car ride [ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ], [ 7 ], [ 8 ]. She also reported symptoms of heightened sensory sensitivity, head pressure, nausea, brain fog, fatigue, and anxiety. She initially displayed cognitive slowing that waned over time, as well as visual-motion sensitivity, both which have been associated with MdDS [ 8 ]. The differential diagnosis of MdDS may include etiologies such as otologic causes of dizziness, vestibular migraine, and motion sickness [ 9 ]. Though the patient denied a lumbar puncture, meningitis was less likely on her differential diagnosis given her lack of nuchal rigidity and fever as well as a normal white blood cell count. Vestibular neuritis was certainly of concern given her disequilibrium, nystagmus, and slight gait disturbance, but the headache, fatigue, and delayed cognition were more pronounced in this patient. In addition, her nystagmus had resolved prior to admission. An initial diagnosis of migraine with aura was considered, but she had no personal of family history of that and there were no known reports to her primary care physician of similar subsequent symptoms.

In Table 1 , a diagnostic guideline is provided for patients with motor travel or spontaneous onset MdDS, as refined with elements adapted from 2018 publication by Mucci et al. [ 5 ] and 2016 guidelines from Van Ombergen et al. [ 10 ]. This guideline may serve as a tool in the diagnosis of MdDS.

MdDS diagnostic guidelines for patients with motor travel or spontaneous onset, refined with elements adapted from Mucci et al 2018 [ 5 ] and Van Ombergen 2016 [ 10 ] guidelines.

CT, computed tomography; MdDs, Mal De Debarquement Syndrome; MRI, magnetic resonance imaging.

It is well documented that patients with MdDS are significantly burdened by depression and anxiety, which further decreases their attention to spatial information and working memory [ 11 ], [ ,  12 ]. The initial psychiatric screening for depression in this patient was negative, but during the period surrounding her disease course, she reported significant anxiety. Of note, during the disease course, the patient was not able to resume work activities and required minimal to moderate assistance with her functional activities. Psychosocial manifestations are common for MdDS patients and should be addressed during MdDS management [ 11 ]. It has been noted that patients with MdDS require an average of 19 physician visits to obtain a diagnosis and that they experience low quality of life in both physical and emotional realms, associated with an annual economic burden of approximately $15,000 USD (based on 2020 inflation adjustment valuation) [ 11 ], [ ,  12 ].

Although a definitive treatment for MdDS does not exist, various medical management protocols are currently in use to help relieve the symptoms of MdDS [ 10 ], [ 13 ], [ 14 ], [ 15 ]. As in this patient’s case, benzodiapine treatment remains widely utilized for symptomatic relief in patients with MdDS, and most patients report a positive benefit [ 10 ]. Other evidence suggests that success and symptom management strategies between benzodiapines and antidepressants do not differ; both are used as primary treatments [ 14 ]. MdDS and migraines share common pathophysiologic mechanisms, so some practitioners have found success treating MdDS with more cost-effective options such as a vestibular migraine protocol that includes lifestyle changes and prophylactic migraine pharmacotherapy with verapamil, nortriptyline, topiramate, or a combination [ 15 ]. Managing patients’ stress has also proven to be an important component of treatment. Ghavami et al. [ 15 ] reported that 11 of 15 patients (approximately 73%) noticed a significant reduction in symptom severity with prophylactic migraine therapy combined with lifestyle changes such as stress reduction and engagement in physical activity.

Considering that osteopathic physicians are trained to incorporate a holistic approach to their practice, they may well be suited to treat this patient population’s symptoms of disequilibrium together with the concomitant socioeconomic impacts. A deeper understanding of environment and lifestyle along with concurrent medical management could be greatly beneficial. Modulating neuronal circuits with repetitive transcranial magnetic stimulation (TMS) over the dorsolateral prefrontal cortex has been reported to decrease the rocking and dizziness of MdDS [ 16 ]. Furthermore, it has been suggested that the vestibulo-ocular reflex (VOR) may serve to treat the postural instability associated with MdDS [ 17 ]. A study by Dai et al. [ 17 ] suggested VOR resetting by rolling the head from side to side coupled with optokinetic stimulation, which showed 78% immediate improvement in 120 patients with classic MdDS. As noted, these prevoius studies were relatively small in sample size and, in most cases, were not rigorously controlled trials, so further research is needed.

Conclusions

This case report highlights the clinical course of MdDS, which remains a poorly recognized, poorly understood, and likely underdiagnosed condition in the medical community. Workup usually reveals no findings and diagnosis is based on history and examination findings. As the first point of contact, family physicians and emergency physicians play a critical role in early suspicion and diagnosis of MdDS. This is especially important, as a delayed diagnosis is common and contributes to the significant social and economic burden associated with MdDS. Despite some progress, clinical trials on the efficacy of approaches to MdDS treatment and management are still in early stages, and definitive treatment still remains modest at best. With a focus on the body as a unit, osteopathic physicians could provide benefits to this patient population based on their holistic approach to care.

Research funding: None reported.

Author contributions: Drs. Ampomah and Burwell provided substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; Dr. Ampomah drafted the article Drs. Clark and Arnold reviewed it critically for important intellectual content and helped revise the manuscript; all authors gave final approval of the version of the article to be published; and all authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Competing interests: Authors state no conflict of interest.

Informed consent: Informed consent was obtained from the patient included in this study.

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© 2021 Kwasi K. Ampomah et al., published by De Gruyter, Berlin/Boston

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Family speaks out after getting stranded in Alaska mid-cruise

Plus, the cruise line said it will offer a discount on a future voyage.

A cruise vacation through Alaska turned into a travel nightmare for one Oklahoma family who got stranded without their belongings after a mishap with a local excursion caused them to miss their ship's boarding window.

The Gault family, including six young kids and a 78-year-old grandmother, are now safely back home from Ketchikan. They had disembarked from the Norwegian Encore on Friday, July 12 to see a lumberjack show that they booked through the cruise line.

"When you talk about cruise nightmares this is the definition of it," Joshua Gault told "Good Morning America" of the incident.

He said when they tried to get back to the ship, the local tour operator had told them to wait for the next bus. But that bus never arrived. The family said they called the local port agent who rushed them to the ship, only to see it already pulling away from the dock with their belongings, including some of their passports.

"I was in shock, like utterly shocked," he said, recalling thinking at the time, "Are they really doing this right now?"

The Gaults said they quickly reached out to Norwegian. His wife, Cailyn Gault, told "GMA" that "the people that I was speaking with were so empathetic, they were apologetic -- they're like, what do you need?"

The family said they had to cover the cost of their own food and hotel and find their own way back to Oklahoma -- a journey that included sleeping on airport floors.

"It was completely overwhelming," Cailyn Gault said.

The family said they estimate the unplanned change cost them more than $21,000 just to get home, which included nearly $9,000 in customs fees for missing a stop in Canada. They said Norwegian is working with them to make it right.

"I think we are on a right path as far as both agreeing that something bad really happened here," Joshua Gault said.

A spokesperson for Norwegian Cruise Line told ABC News in an emailed statement that the company "will be reimbursing the family for all of the out-of-pocket expenses they incurred over these two days, as a result of missing the ship in Ketchikan, including meals, accommodations, etc. Reimbursements will be processed once receipts for these expenses are provided to us."

NCL said it has "initiated the process to refund the family for the fee imposed by the U.S. Customs and Border Patrol, as a result of the guests not visiting a foreign port prior to returning to the U.S., as required when an itinerary originates from the U.S. in accordance with the Passenger Vessel Services Act."

Additionally, the cruise line representative told ABC News that "these guests will be receiving a pro-rated refund for the two cruise days they missed."

"As a gesture of goodwill, the company will also be providing each of the nine guests with a Future Cruse Credit in the form of a 20% discount of their cruise fare that can be used towards their next voyage," the spokesperson said.

Experts say if you leave your cruise ship for an excursion, always bring a government-issued photo ID and the name and number of the port agent, who is the best person to help travelers who may run into trouble.

"The port agent is the cruise line's representative in that port," Stewart Chiron, founder of The Cruise Guy, said. "In this case, contacting the port agent was the best move because they would be able to contact the ship."

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A family was left behind in Alaska while on a cruise — then charged $9,000

The gault family felt forgotten as their cruise ship — with medication, passports and personal belongings — left without them.

By Caroline McDonald

An Oklahoma family had the trip of a nightmare when they were left behind by their cruise ship in Alaska.

Cailyn Gault, one of the family members left behind, told KJRH about the experience. “We’re still looking into it, we haven’t forgotten about you and I was like, ‘no we feel like you pretty much forgot about us when you left us in port and told us to go figure it out,’” she said.

The nightmare vacation

According to KJRH , the family’s trip started out as a family reunion on board the Norwegian Encore, a ship that’s operated by Norwegian Cruise Line . For the group of 16 people, the trip reportedly cost roughly $30,000.

Nine family members disembarked in Ketchikan, Alaska, to watch a show. When they attempted to board a bus to get back to the ship, they were told it was full and they needed to wait for the next one. Even though the family had tickets, the bus never came back.

“We see the chaos getting onto the buses. We go to get on the bus and one of the attendees is like ‘The bus is full, and you know you got to wait for the next bus,’” Joshua Gault told KJRH. The family also said that the ticket attendant wasn’t checking tickets, which meant that people from another ship could take their seats.

The family called a van to take them back to port, but by then, it was too late. The ship had left with their belongings on board, including medication and passports.

“You know, it was a nightmare. Six kids on board, minor children, and a 78-year-old mother-in-law, all on medication. We all had to quit cold turkey medication these last few days because it was all on the cruise ship,” Gault said to KJRH.

The family couldn’t catch up with the ship at its next port in Canada, per Local 12 . The consequence was a nearly $9,000 charge, about $971 per person.

The Gaults told KJRH that the family had to pay for everything to get home, including hotels, flights and food. During the hassle, their credit cards were charged the $9,000 fee.

“You know, Norwegian treating this like it was a customer service issue rather than it was an emergency is, I think, the worst part about it,” he said.

Additionally, members of the family caught COVID-19, leaving them “beaten down” and “unhealthy,” according to Gault.

Per KJRH, the cruise line released a statement on what happened at 8 p.m. on July 16:

“We will be reimbursing the family for all of the out-of-pocket expenses they incurred over these two days, as a result of missing the ship in Ketchikan, including meals, accommodations, etc. Reimbursements will be processed once receipts for these expenses are provided to us. Additionally, we have already initiated the process to refund the family for the fee imposed by the U.S. Customs and Border Patrol, as a result of the guests not visiting a foreign port prior to returning to the U.S., as required when an itinerary originates from the U.S. in accordance with the Passenger Vessel Services Act.”

The statement continues, “In addition, these guests will be receiving a pro-rated refund for the two cruise days they missed. As a gesture of goodwill, the company will also be providing each of the nine guests with a Future Cruse Credit in the form of a 20 percent discount of their cruise fare that can be used towards their next voyage.”

I've taken over 30 cruises by myself. I was lonely for a few until I realized I'd cracked the code for the perfect getaway.

• I love cruises, but I was hesitant to go on them alone because I thought I'd be lonely.
• I was lonely at first, but less so once I did what I wanted and stopped worrying about socializing. 
• I love that  cruising solo allows me to relax and see the world on my own terms.

I'm in my 60s, and I've been fortunate to take more than 30 solo cruises over the past 15 years.

I started doing so after I discovered that I love going on cruises , but my wife did not. Fortunately, she's fine with me taking off by myself — I'm not sure whether it's because she wants to make me happy or just likes to periodically get rid of me for a while.

Either way, my choice was to cruise solo or not at all. I opted for the former.

My first few cruises were lonely until I freed myself of solo-travel expectations

The first few times I cruised solo, I took three- and four-night cruises to see whether I could handle being alone on a ship .

I was a little lonely on those first few cruises, primarily because I didn't know what to do with myself or what was expected of me as a solo traveler.

I felt as if I had to attend tons of ship events and have my meals at shared tables with other people, but it didn't actually make me feel less lonely. I didn't enjoy doing things just for the sake of being around other people, either.

Finally, I asked myself an important question: What was I actually looking to get out of the cruise experience?

I wanted to relax and do what I wanted, not what others expected me to do on a cruise .

So, I stopped prioritizing socializing and started only doing things that furthered my own enjoyment. I found these things weren't dependent on being with others, and I became more at peace with being alone .

Eventually, I increased the length of my cruises to seven, 10, and even 16 nights. I'm still amazed at how fast time seems to pass on a ship.

I love getting to do what makes me happy without worrying about others

Turns out, it's OK to do absolutely nothing on vacation. And I don't need company to enjoy the benefits of being on a cruise .

I found that I like spending meals alone with a book, free from feeling obligated to converse or wait for others to finish eating before enjoying my next course.

Going to the nightly onboard shows is still fun for me, but I stopped doing onshore excursions that don't further my relaxation. Sometimes, I just watch movies on the television in my cabin.

Although I no longer prioritize socializing, I still strike up conversations with people often, and I welcome those who ask to join me when they see me sitting alone.

Related stories

But above all, cruising solo has taught me to be more comfortable in my own skin and more confident in myself. It's also allowed me to see the world without waiting for others.

I've now traveled throughout North America and made bucket-list trips to Antarctica and Iceland.

These days, the one downside of being alone is having to pay the dreaded single supplement, which usually doubles a cruise's base fare. But by booking an inside cabin , I can somewhat mitigate this cost of traveling solo.

Watch: Why it costs $1 million a day to run one of the world's biggest cruise ships

• Main content

27 cruise ship embarkation day do’s and don’ts

You've planned your cruise, and now it's embarkation day. You can't wait to get on board your ship and relax, sip a tropical drink and stare out to sea. You're on vacation – woohoo!

Not so fast. You might be ready to cruise, but the ship's crew still is getting the ship ready, having just disembarked last week's passengers.

You must go through the ship's pier-side check-in process, which can take time. Remember, you are one of thousands of people entering a floating city at basically the same time. As with any other secured structure, you can't walk right onto a ship.

The best way to start your cruise is to arrive at the pier expecting some lines and minor hassles — and perhaps a bit of chaos — and then be thrilled if you don't encounter any of them. Keep a level head and look forward to good times once your sailing gets underway.

For more cruise news, reviews and tips, sign up for TPG's cruise newsletter .

Here are some dos and don'ts to help make embarkation day as hassle-free as possible.

DO check that you have the necessary paperwork and documentation

The cruise line will send pre-cruise reminders explaining what to expect at check-in, including health and safety procedures. It will outline which documents, IDs, QR codes or other electronic receipts you must have ready.

However, it's your responsibility to arrive at the pier with the proper documentation. I like to print out and bring paper copies of documents as a backup to electronic documents.

Related: Do you need a passport for a cruise?

DON'T arrive at the pier early

Many cruise lines assign passengers a staggered time to arrive at the pier. Arrive early, and you'll just have to wait — often, outside in the hot sun, without access to water, restrooms or other necessities. Arrive at the pier as close as you can to your scheduled time, but don't freak out if you are a few minutes late. You won't be turned away.

DO hand over your big suitcases

As soon as you arrive at the pier, porters will be available to take your large suitcases, which will be delivered later to your cabin. (Dock workers expect a small tip for the service.) Without your luggage, you'll have your hands free for the rest of the embarkation process. Make sure your suitcase is tagged with your name and cabin number, ship name and sail date.

DON'T relinquish your carry-on bag

In your cruise carry-on , pack your medications, valuables, documents and anything else you will need until your luggage arrives in your cabin. Since you're likely leaving from a sunny destination, you also might want to have a sun hat, sunscreen and sunglasses. If you've come from a cold-weather place, pack shorts, flip-flops and your bathing suit so you don't have to wait for your suitcases to arrive before you hit the pool.

DO be prepared to go through security

Once you prove (through your paperwork or electronically) that you belong on the ship, you will go through security. The setup is similar to an airport. You put your belongings on a screening belt and walk through a metal detector. You won't have to take off your shoes but will have to remove belts and bulky jewelry and clear your pockets.

DON'T try to sneak any banned items onto the ship

Your carry-on items will be inspected via an X-ray machine at the security checkpoint, and your checked bags might be searched before they're delivered to you. While most cruise lines allow passengers to bring a small amount of alcohol, soda and bottled water for consumption in their cabin, make sure you have not gone over the cruise line's allowance for bringing your own beverages on board .

Cruise lines have specific rules for other banned items, which you can find on your line's website. These items will include weapons, fireworks, flammable liquids, candles, clothing irons, incense and anything else that produces a flame. Royal Caribbean also bans martial arts gear, baby monitors and extension cords, among other items. Carnival bans handcuffs.

DO freshen up

After your flight or drive to the port, you will want to freshen up because the fun begins at the embarkation pier. You'll find both official and unofficial photo spots at the terminal. Smile for the shipboard photographers, who will have a backdrop with the ship's name or picture set up, or take your own photos.

DO pause and look up as you enter the ship's atrium

Some ship atriums are impressively high or have cool artwork or chandeliers hanging from the ceiling. You've arrived at your floating home for the week. It's OK to stand in awe.

DON'T expect to be able to go right to your cabin

Depending on when you arrive, cabins might not be ready, as the crew needs to clean and straighten them after the previous guests have left. It's best to stay out of the way of the cabin stewards and instead find a place for you (and your carry-on luggage) to hang out until the ship announces all cabins are ready.

DON'T follow the crowds to the buffet

As the boarding process begins around noon and continues well into the afternoon, many people arrive hungry. Crew members often direct passengers to the buffet — but experienced cruisers know there are other, often less crowded, options.

On Carnival Cruise Line ships, go directly to celebrity chef Guy Fieri's poolside Guy's Burger Joint and indulge in a decadent burger or fries. If you're on one of the newer or recently updated Carnival ships, there's also the embarkation day treat of Fieri's pork butt, chicken and Mac Daddy Mac n Cheese served on the promenade (or Deck 10 on Carnival Sunrise).

Royal Caribbean fans in the know make a beeline to the Park Café for Royal Kümmelweck roast beef sandwiches, an embarkation day rite of passage. A main dining room with waiter service and specialty for-a-fee restaurants also might be alternatives for an embarkation day lunch.

DO head to your cabin when it's ready

Your big bags might not have arrived at this point, but you can drop your carry-ons and take a look to see that everything is to your satisfaction. Your cabin steward likely will stop by to say hello. This is a good time to ask how the air-conditioning, TV and safe work and to ask for any extras you might need, such as more towels, pillows and hangers, or to have the bed split from a queen into two twins. The steward will also let you know how to keep in touch if you need anything extra throughout your cruise.

DO read the safety instructions and check life jackets

Safety instructions will be posted on the back of your cabin door. Look there for the number of your assigned muster station in the event of a shipboard emergency. You'll find life jackets in your closet or elsewhere in the cabin. If you are traveling with kids, now is the time to make sure there is an appropriate infant or child life jacket in addition to a life jacket for each adult. If there isn't, alert your cabin steward.

DO watch the safety video

It used to be that everyone on a cruise ship was required to gather on embarkation day at their assigned muster station, listen to a safety briefing and be checked off a list as having been briefed. As a result of COVID-19, and a desire to keep crowds at a minimum, many cruise lines have moved to e-muster drills.

You are required to watch a video on your cabin TV or cruise line app that tells you what to do in the event of a fire or other shipboard emergency. Your smart TV or app will record that you have watched the video. You may also be required to check in with a crew member at your assigned muster. Those who skip this step will hear their cabin numbers called out over the PA system, which can be embarrassing.

DO make sure the kids understand the safety procedures

Eyes might roll, but now is the time to talk to the kids about the danger of climbing on any railings or standing on balcony furniture. Remind them that other people on the ship are strangers and that they should use the same caution they would at home. Establish rules for how much freedom children are allowed to have on board, where to leave messages for each other and how to reconnect if you get split up on the ship.

DO go out to explore the ship

You'll have time to see a lot during your cruise, but at this point I like to get the lay of the land. You might find a ship deck plan (map) in your cabin, or one might be available at the purser's desk or in the cruise line's app. It's fun to find not only the main spaces but also the hidden pools, hot tubs and other treasures you'll want to return to throughout your sailing. It's fun to do the exploring as a family.

DO sign the kids up for cruise ship camp

While you're exploring, stop by the kids' centers and sign the kids up for the onboard kids program . Staff will be on hand to welcome your progeny and show them around the play spaces and hangouts available just for them. Your kids might need to get bracelets marked with their muster station in case of emergency.

Related: Best cruise ships for kids

DO stop by the spa and fitness center

If you plan to do spa treatments or have hair and other beauty appointments during your cruise, now is the time to book them (if you haven't booked them in advance). Take the spa tour and sign up for the raffle — you could win a free treatment.

If you like what you see in the soothing thermal suite — which typically has hot and cold treatments — sign up now as spaces often sell out. Put your name on signup sheets for fitness classes, as these also fill up quickly.

DO take time to veg out

You don't need to do everything your first day, so if you spot a perfect spot in the sun or shade, rest your weary bones. Fun times are ahead; a little cat nap might be in order.

DON'T assume drinks are free

As you wander, especially out on deck, smiling crew members will be carrying trays of tempting and colorful icy drinks, maybe even decorated with sweet little umbrellas. Go ahead and grab one if you want — just understand you will be charged for the welcome drink.

DO watch your alcohol consumption

We get it, you bought a drinks package (in which case the above drink is included), and you want to make the most of it. But do you really want your first day on board to result in an unpleasant morning after? Better to pace yourself and drink lots of water between adult beverages.

DO take time to unpack

Once you've got the lay of the land, you probably want to unpack and get ready for your first evening on board. Don't put your luggage directly on your bed's duvet; use the luggage mat provided. Find a spot for everything because cruise cabins can quickly become cluttered. When you're finished, stow your suitcases under your bed.

DO call if your luggage hasn't arrived

It takes time to deliver thousands of suitcases to thousands of cabins. But if it's getting close to the time your ship is set to leave the pier and your suitcases have not arrived, alert your cabin steward. (If you've had a last-minute cabin change, look for your luggage by your original room.)

DO take your seasickness tablets

If you are prone to seasickness , plan to take your first pills a couple of hours before the ship is scheduled to leave the pier. They need time to kick in.

DO turn off your cellphone

To avoid costly roaming charges, you will want to keep your cellphone on airplane mode. To keep in touch with those at home and brag about your trip on social media, consider buying a shipboard Wi-Fi package . Crew members will be on hand on the first day to help you log in and connect.

DON'T forget to figure out dinner

Perhaps you plan to head to the main dining room the first evening or want to go casual at the buffet. Consider the option of specialty dining . These intimate, for-a-fee restaurants can be hard to get into (reservations are required) but are usually not as crowded on the first night of the sailing. Plus, some lines will thank you with a complimentary or discounted bottle of wine.

Related: The ultimate guide to cruise ship food and dining

DO check out the daily program

You'll find a list of all the daily activities printed out in your cabin, on your cabin TV or on the shipboard app. Take a look and see what's in store for your first evening aboard.

DON'T miss the sailaway party

This is the first big activity of your cruise and not to be missed. These parties are about music, laughter and the opportunity to check out the crowd you'll be with for the week. Plus, watching the land disappear as your ship heads to sea is a dreamy experience. You're off to new horizons. Grab a drink and toast the official start of your cruise vacation.

Planning a cruise? Start with these stories:

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Breaking news, scammer cancels unsuspecting calif. family’s $900 carnival cruise trip just days before ship set sail.

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A California mother was purportedly scammed out of going on a Carnival cruise with her children that she had planned a year in advance — and initially lost $900 — after she fell prey to a fraudster, according to a new report.

Brittany Paine, of Castaic, was set to voyage to Ensenada, Mexico, over Mother’s Day weekend, but her plans were shockingly wrecked when her Carnival booking was canceled just days before, leaving her on the verge of tears.  

The sea-sickening scam began when she called a number for what she thought was Carnival about a cabin upgrade and spoke to someone who claimed they were a company rep, according to NBC 4 LA.

“We noticed here that you have an outstanding balance on your upcoming cruise for $294,” she said the so-called rep told her, “and you will not be able to board if that’s not taken care of.”

She paid the “deck fee” and hung up, but instantly grew suspicious and dialed another number for Carnival. An actual Carnival rep on the phone this time told her a “deck fee” didn’t exist.

“She said, ‘No, ma’am, that was a scam,’” Paine told NBC 4 LA this week. “’We wouldn’t have charged you a deck fee. Go ahead and dispute that with your bank.’”

She disputed the charge and got her money back, but that wasn’t the worst of it.

“I get an email alert that pops up on my phone. It says, ‘Your cruise has been canceled.’ And my heart sank,” the devastated mom recalled to the station.

Paine told the outlet that Carnival said someone had logged into her account and canceled her trip. She suspects the fake rep, who had asked for her booking number, was behind the cancellation.

“I was in tears. I said, ‘Please, this is Mother’s Day weekend with my kids,’” she said.

But the cruise line couldn’t help her. Her cabin was already rebooked to another customer and the ship was full, leaving Paine marooned at home.

The mom also lost the full $900 cost of the cabin — as the cancellation happened within 15 days of the cruise date, per Carnival’s policy. But she was refunded after NBC 4 LA reached out to the company.

“To come up with $900 for a trip for my kids, it was only feasible by making payments and taking out a loan. So it was a lot of money for me,” she told the local station.

The Post has reached out to Carnival for comment.

“Unfortunately scammers target travelers,” a company rep said in a statement to NBC 4 without sharing any details on Paine’s case.

Paine, who plans to jump on a cruise with her kids later this summer, warned others to watch out for cyber-criminals.

“Nobody is safe from these scams. And they get better and better,” she said. 

A Kentucky family fell victim to a similar scenario in May when their $15,000 Carnival vacation was canceled two days before their cruise date.

The couple had accidentally shared their booking number on social media by posting a screenshot of an email with a countdown to the cruise that also listed the number. Someone then used the number to cancel the family’s trip.

Advertisement

After water pistols in Barcelona and hunger strikes in Spain, cruise ships may avoid European hotspots where ‘passengers will not be well-treated’

T he European head of the world’s largest cruise trade body has warned that its members may need to avoid some of the world’s most famous destinations to protect passengers amid a backlash against overtourism. 

Several European cities have vented their frustrations over rising tourist numbers and its impact on the price of everything from food to accommodation and the local ecosystem. Tourism’s environmental footprint is a complaint usually levied at giant carbon-emitting cruise ships. 

In Barcelona, a popular setting-off point for cruise liners, locals have taken to squirting tourists with water pistols . Protestors in the Spanish Canary Islands started a hunger strike in April to protest overcrowding. 

Last October, cruise passengers were greeted by protesters dressed as polar bears and sea lions as they disembarked at the French port of Brittany, in a nod to the industry’s penchant for pollution. 

A study from the campaign group Transport & Environment found Europe’s luxury cruise ships emitted as much toxic sulphur as 1 billion cars. 

A rising tide

As protests have become increasingly hostile, the Cruise Lines International Association (CLIA) has suggested that it may have to divert ships to protect passengers from violence.

"There will be some consideration of adapting the itineraries if for some reason we feel that all passengers will not be well-treated," Marie-Caroline Laurent, European director of the CLIA, told Reuters . 

Laurent didn’t specify which cities were liable to be axed from itineraries, but it’s easy to join the dots after a wave of protests across the continent in recent months. 

The mayor of Barcelona, Europe’s most popular port for cruise ships, said the city couldn’t take more passengers than the 3.5 million it accepted in 2023.

The CLIA defended its presence in Barcelona, saying only 4% of the city’s visitors were cruise passengers.

Venice, which banned cruise ships from the center in 2021, introduced a so-called “ tourist tax ” to deter or make extra money from day-trippers to the city this summer, months after moving to limit the size of groups that could congregate in the city.

Amsterdam, meanwhile, plans to nearly halve the number of cruises that can stop in its port every year by 2026 and ban them altogether by 2035.

And in Greece, locals have taken to using drones to police new rules on sun loungers in a bid to stop overcrowding on the country’s beaches.

Despite grumbling about a rising lack of hospitality, the global cruise industry is set to carry 10.7% more passengers in 2028 than in 2023, when 31.7 million tourists boarded the liners. 

This story was originally featured on Fortune.com

• Ask a Cruise Question

Cruising with vertigo

By firstevercruise , July 30, 2011 in Ask a Cruise Question

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firstevercruise

I have been having periodic dizzy spells and the doctor has diagnosed vertigo. I am on day 3 of quite a debilitating episode that forced me to take 2 days off work. There is no cure and i am prescribed medication to help with the symptoms.

I am cruising for the first time next year (lifelong dream of mine) and I am worried that the movement of the ship will bring on my symptoms.

Is there anyone else on this board that cruises with vertigo that can tell me if cruising will exacerbate my symtoms?

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I can't speak to how its going to effect you, but I also have vertigo and have had it for quite a few years now. I don't take any medication for it, and it does sometimes leave me stuck in bed for days at a time. I did not have any issues on my cruise to Alaska some years ago. I did take sea-sickness pills the first day as a precaution and during the storm when we had 11 foot seas. I didn't notice that they did me any more harm then say a benadryl does (perhaps a slight increase dizziness but who can tell when the room really IS spinning).

You'll find most cruise ship showers/tubs are equiped with lots of handles in case there are rough seas, and the hallways typically have handrails etc. So there's usually something to grab on to if you start to feel dizzy.

I did find that the vibration from the engines came through my bed and it took me a day or two to get used to that, not swaying but slight shaking. However that didn't seem to increase my vertigo.

You may get lucky, and not have a spell while on the cruise. But unfortunately we can only tell you how it effected us, there's no predicting how it will effect you. We all have different triggers.

Thanks Skye

As I have just been diagnosed I am not sure what my triggers are, but I have noticed over the past few months that when I am stressed at work I have dizzy spells, so perhaps stress is my trigger. Not sure if anything else will trigger it in the future!

It is horrible though, I hate being drunk (I rarely drink) but this vertigo makes me feel drunk.

Never mind, i will adapt to it and I am planning a stress free cruise so hopefully will avoid an episode on the ship. I will ask my doctor for some pills just in case it happens!!

Thanks again

I have the same problem, but my spells are brought on by rapid movement of head. No snap head movements for me. I have been on 4 cruises with no problem...

I, too, have sailed with vertigo, and found if I just don't make any sudden movements I can usually cope very well. I take motion sickness meds and Ginger pills that are really a life saver, sometimes.

Low and slow is probably good advice. Don't overbook your schedule, make sure you leave breaks to rest. I find I have more vertigo when my sleep schedule is off or I'm not getting enough sleep. Although sometimes it just happens, I had a spell hit me today and I spent 4 hours trying to nap in bed instead of doing work I'd planned to do today that people had come over to help me with. I had to apologize, excuse myself and tuck myself in until it passed. I find a nap often clears things up, often when I wake up I'm either no longer dizzy or not AS dizzy.

I would suggest you not book optional excursions every day of the cruise, or try to do them back to back. I would also look into what each excursion entails. For instance - as much as I wanted to see Denali National Park, had I known that the excursion to the park provided by HAL as part of the land tour before the cruise meant spending close to 6 hours stuck in a stripped down school bus climbing up mountain roads. Well, lets just say that when your only 2 scenic options are "off the side of the mountain down a steep ravine" and "rock wall blitzing by at probably less mph then it felt like" - I'd have passed. The fact I was recovering from food poisoning that day didn't help either. My only consolation was all the fellow bus-goers who teased me for keeping my head down and muttering to myself on the trip UP the mountain, got to be on the outside of the bus looking down the ravine on the way down and had a change of heart ;)

Lots of rest, lots of sleep, don't push yourself. If you have to cancel on an optional shore excursion - then don't think too much about the money, cancel and rest. And if you don't have it already - trip insurance in case you need to rebook the entire cruise for any reason.

Thanks to everyone for the replies, i appreciate your advice.

Think i may have a rest now if I can catch the bed!!

My husband has some problems with vertigo, he always starts the cruise with a patch behind his ear, and that seems to help. But I would suggest that you discuss your concerns with your Dr. they might have the answers you need. Hope you enjoy your cruise.

cinnamon123

ive had vertigo about 10 yrs. now. the antivert med.made it worse

i found. had me awake all night. i went through 2 hour testing with

an audioligist. the best advice he gave me & which i read, was when

the room starts spinning, to STARE at a stationary object even if

it's one finger. this will stop it. also, don't reach down & into a cabinet

or tilt your head back for something high on a shelf.

cruising has never bothered it, thank goodness!

i do hope this advice i gave you helps.

good luck & hope you have a great cruise.

cinnamon123:)

I reciently went to a specialist,eyes,ears,hose throat etc which includes balance and vertigo, He told me my problem was fairly minor , no meds at least at this time. He did send me to a rehibilation place that showed mr a kot of exercises involving walking, eye exercises and other exercises that did seam to help a lot. They also told my the problen was mild and to keep up the various exercises. Last comment, on a cruise a couple of years ago a commedian said that with the rough seas we were having the dunks will look normal because everyone was weaving as they walked

Colorado Kat

Definitely talk to your doctor. Do it early, as he might have to research options.

Do you have your cabin booked yet? Would something low and in the center of the ship help? An ocean-view?

I was going to a physical theropist for vertigo and balance problems. He advised me that a lot of anti-motion TOC meds have a possible side effect of causing dizziness. Again check with a MD.

cruisehappi

All of the above-mentioned symptoms are all too familiar to me as well. I don't take any meds for it. I used to worry it would happen on a cruise, but it never has. I did take motion-sickness pills on one cruise, but that was only to ward off stomach upset due to high sea swells. You will feel quite comfortable aboard ship - plenty of handrails everywhere if you happen to feel any rocking. Out on deck is the easiest - lots of wide open spaces.

Stop worrying and look forward to your cruise!

Thanks everyone

I have booked a deck 7 midship balcony, originally i had an inside but thought a view of the horizon might be helpful. I have not had an episode for a week, hopefully the really bad episode I had last week was a one off!

I will speak with my doctor, i am not missing my cruise for anything!!

I too as diagonosed with Vertigo a month ago. Went to be "flipped" twice it didn't help. But, long story short is, went on a Sail Boat here locally abut a week ago, I did just fine! I felt like I was finally normal, as I had been walking around like I was on a boat for the past month! I didn't feel a bit queasy either. I have a script for Meclazine. I cannot take it because it makes me dizzy and drowzy.

Hoping it will completely go away soon! Good Luck to you!!!

Ask your doctor about the epely procedure which is done by an OT or PT or ENT doctor. It is a series of slight turns of the head which clear the ear of the little crystals that cause the vertigo.

I don't normally have vertigo but I get it every time I cruise and it lasts for about a month. Things that help me are to spend time looking straight ahead every day on the ship (on all the Carnival ships I've taken, the gym is the best spot for this), not taking any boat excursions or vehicles in ports (walking and sitting instead) and going to the chiropractor before and a few times after the trip.

• 4 months later...

the one thing no one has addressed (unless I missed it) is: is it better to have an inside cabin or outside cabin? I would like to know before I book the room. My last episode was 4 yrs ago. I've had an MRI, seen the ENT specialist, done the various exercises etc. That yr, I had 3 episodes in 4 months. Certainly do not want to have again. Yes, I turn my head slowly and start sleeping in the sitting position then eventually slide down.

please let me know which cabin location is best.

Please, anyone suffering from this, talk to your doctor about balance/vertigo therapy. My mother had debilitating vertigo for months while her doctors ruled out everything from brain tumors to heart problems. The therapy got rid of the vertigo within a couple of sessions. It's a combination of physical movements done by the therapist, and training that they give you in simple exercises to do at home. She's been free of vertigo, without medication, for nearly a year now. It's been life changing for her, she was afraid to even go shopping while that was going on.

I don't have vertigo, but the one time I had an inside cabin I did feel seasick. I also try to take a shower when the ship isn't moving; something about standing in the enclosed space

when the ship is moving makes me dizzy.

I don't have vertigo, but the one time I had an inside cabin I did feel seasick. I also try to take a shower when the ship isn't moving; something about standing in the enclosed space when the ship is moving makes me dizzy.

Agree with this. I have periodic bouts of vertigo that can be debilitating for a couple of days. Mine might be related to migraines- I'm not sure. They are similar in symptoms except I don't get the headache. I know it's similar to a migraine because I *used* to have traditional migraines for some years before I had children. Once I had kids, the migraines disappeared, but I continued to have occasional vertigo attacks.

Anyway, I have never had problems on the cruise. I have had seasickness but it did not feel anything like vertigo and meclizine cleared that up. The time I had seasickness was in a porthole cabin in rocky seas. We've had balconies for the past 2 trips and haven't had any seasickness. Also, when I did have seasickness, the shower felt the worst. I tried to time my showers for when we were in port and weren't moving. My other trips the weather was good enough that it didn't matter.

I also agree with the others that if you're going through a vertigo bout, or are just recovering from one (my recoveries usually took a long time until I didn't feel any spinning at all), then be careful how you move your head. No sudden movements, don't tip your head over if you can help it. Mirrors also bother me. I have no idea why. But I've noticed that if I make certain head movements while looking in the mirror it can make me feel dizzy.

How often do you get vertigo bouts? I can go years without having one and then have a couple in a row.

I have vertigo caused by a vestibular problem & take meclizine every day as a matter of course. When I cruise, my doc always prescribes the patch which I wear faithfully. We have had a couple of rough cruises & I wear the wristbands when I can feel the motion. This may sound like a lot of trouble to go to, but I do love to cruise & it's worth it to me to be able to go. I also have the doc's permission to increase my meclizine when necessary.

• 4 weeks later...

tllovecruise

I had it for 3 weeks and tried a new age technique to get rid of it. Lifeline. It worked thank goodness. People were commenting that i couldn't walk straight and i was getting really tired of it.

Debbie Loshbough.

www .lifelineatl .com

This topic is now archived and is closed to further replies.

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American teen missing in Germany after leaving cruise ship, police say

An American teenager disappeared during a cruise in Germany, police said.

Aydin Brown, 14, was last seen at 7 a.m. Thursday when he left the Caribbean Princess in Rostock-Warnemünde, a port town on the Baltic Sea, police said.

He is about 5-7, has long dark hair and was last seen wearing a dark jacket, dark pants and retro shoes, police said.

Princess Cruises said in a statement Friday that it is actively working with German police in the search for the teenager.

The boy left the vessel without an escort, the statement said.

“We understand the distress this situation has caused and will continue to provide ongoing on-site support to the family during this challenging time,” Princess Cruises said.

The teen's grandmother, whom Brown was traveling with, left the ship Thursday night and is being helped by company employees in Warnemünde. Princess Cruises also arranged for his mother to fly to Germany as the search continues, the cruise line said.

"We greatly appreciate the swift response and ongoing efforts of the local authorities in their search for the young man," the statement said. "Their dedication and expertise are invaluable in this critical situation, and we are doing everything we can to assist them."

Police are also searching for a witness who may have seen the teen about 7:30 a.m. Thursday at the train station in Warnemünde.

The witness is described by police as between 20 and 25 years old. and has been asked to urgently report to the criminal investigation department in Rostock.

Natasha Worthington, who is traveling on the cruise said that despite the teen's disappearance, “The mood on the ship is still upbeat as not a lot of people are talking about it."

She said she has little information about the situation, adding "we would like to know what’s happened as we feel extremely sorry for the family.”

Carlo Angerer is a multimedia producer and reporter based in Mainz, Germany. 

Antonio Planas is a breaking news reporter for NBC News Digital. 

Family speaks out after getting stranded in Alaska mid-cruise

A cruise vacation through Alaska turned into a travel nightmare for one Oklahoma family who got stranded without their belongings after a mishap with a local excursion caused them to miss their ship's boarding window.

The Gault family, including six young kids and a 78-year-old grandmother, are now safely back home from Ketchikan. They had disembarked from the Norwegian Encore on Friday, July 12 to see a lumberjack show that they booked through the cruise line.

"When you talk about cruise nightmares this is the definition of it," Joshua Gault told "Good Morning America" of the incident.

He said when they tried to get back to the ship, the local tour operator had told them to wait for the next bus. But that bus never arrived. The family said they called the local port agent who rushed them to the ship, only to see it already pulling away from the dock with their belongings, including some of their passports.

"I was in shock, like utterly shocked," he said, recalling thinking at the time, "Are they really doing this right now?"

The Gaults said they quickly reached out to Norwegian. His wife, Cailyn Gault, told "GMA" that "the people that I was speaking with were so empathetic, they were apologetic -- they're like, what do you need?"

The family said they had to cover the cost of their own food and hotel and find their own way back to Oklahoma -- a journey that included sleeping on airport floors.

"It was completely overwhelming," Cailyn Gault said.

The family said they estimate the unplanned change cost them more than $21,000 just to get home, which included nearly $9,000 in customs fees for missing a stop in Canada. They said Norwegian is working with them to make it right.

"I think we are on a right path as far as both agreeing that something bad really happened here," Joshua Gault said.

A spokesperson for Norwegian Cruise Line told ABC News in an emailed statement that the company "will be reimbursing the family for all of the out-of-pocket expenses they incurred over these two days, as a result of missing the ship in Ketchikan, including meals, accommodations, etc. Reimbursements will be processed once receipts for these expenses are provided to us."

NCL said it has "initiated the process to refund the family for the fee imposed by the U.S. Customs and Border Patrol, as a result of the guests not visiting a foreign port prior to returning to the U.S., as required when an itinerary originates from the U.S. in accordance with the Passenger Vessel Services Act."

Additionally, the cruise line representative told ABC News that "these guests will be receiving a pro-rated refund for the two cruise days they missed."

"As a gesture of goodwill, the company will also be providing each of the nine guests with a Future Cruse Credit in the form of a 20% discount of their cruise fare that can be used towards their next voyage," the spokesperson said.

Experts say if you leave your cruise ship for an excursion, always bring a government-issued photo ID and the name and number of the port agent, who is the best person to help travelers who may run into trouble.

"The port agent is the cruise line's representative in that port," Stewart Chiron, founder of The Cruise Guy, said. "In this case, contacting the port agent was the best move because they would be able to contact the ship."

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Thinking About a Mississippi River Cruise? There’s One Big ‘If.’

Though operators are building ships, and towns are investing in landings and other infrastructure, fluctuations in the river’s flow, exacerbated by climate change, are hampering sailings.

By Rowan Moore Gerety

Rowan Moore Gerety spoke to civic leaders, cruise passengers and several cruise-industry businesses focused on the Mississippi River.

Tom Trovato and his wife, Trish, paid more than $20,000 and waited two years to experience Viking’s inaugural cruise up the Mississippi River. Leaving in September 2022, it was supposed be a two-week excursion from New Orleans to St. Paul, Minn., a trip of some 1,800 miles.

They never got past Memphis.

Low water levels, caused by drought, narrowed the river’s main shipping channel to allow only one-way traffic, first stalling their boat, the Viking Mississippi, and then ultimately aborting the trip.

Though they got a full refund, the Trovatos, who live in Surprise, Ariz., have no plans to try again.

“If I live to be 125, it might be on my bucket list,” said Mr. Trovato, 79.

The Mississippi River is central to American identity, with all the contradictions that entails. It’s an artery that sustained Indigenous cultures for thousands of years — “Mississippi” derives from the Ojibwe for “great river” — and it marked the frontier from which Lewis and Clark set out to find a route to the Pacific. The river’s alluvial deposits and deep waters formed the basis of prosperity for generations of farmers, and brought perdition to vast numbers of enslaved people who toiled along its banks and feared little more than being “sold down the river.”

For many people, particularly baby boomers reaching their retirement years, a cruise along the Mississippi River is a dream trip. But it’s becoming harder to make it come true. Though operators are building new ships, and towns and cities are investing in infrastructure to welcome boat traffic, cruises on the Mississippi face mounting challenges from an increasing number of droughts and floods.

Decades of forest and wetland destruction, dam construction and dredging have added to natural fluctuations in the Mississippi’s flow. Now climate change has only heightened the river’s tendency for dramatic seasonal shifts in water levels, frequently rerouting ships and causing delays.

Just late last month, in St. Paul — the final port for the Trovatos’ original itinerary — rising Mississippi River levels forced the closure of shoreline roads , bridges and parks . The river rose 20.17 feet above its banks before cresting, the seventh major flood in St. Paul since 2010, according to the National Water Prediction Service, and the eighth highest crest recorded.

Farther south, Memphis had made its $40 million Beale Street Landing the centerpiece of a larger redevelopment of parks and trails snaking along six miles of Mississippi shoreline. Last year, more than half of the 128 scheduled cruise ship landings there were canceled, mostly because of low water levels that made it impossible for the boats to reach the dock.

In July 2021, an overnight passenger riverboat visited Kimmswick, Mo., for the first time in 125 years, when the 341-foot American Duchess docked at its new landing. The town was expecting the cruise industry to boost tourism in the area. But the American Duchess was also the last cruise to dock there. There hasn’t been enough water for boats to come back until recently: The Viking Mississippi was finally scheduled to land in Kimmswick on Monday, but this time, the water was too high.

“We’re just seeing climate impacts stack up,” said Colin Wellenkamp, the executive director of the Mississippi River Cities and Towns Initiative , a coalition of local governments along the river. “We used to see them every 10 to 15 years, now we’re seeing them where they just don’t quit.”

‘Demand’s not going anywhere but up’

Despite the pandemic, when most travel worldwide was at a costly standstill, bookings on river cruises in the United States rose 25 percent from 2019 to 2022, according to data from AAA, the automobile owners’ group that also tracks air and cruise travel. An analysis by the market research firm Grandview Research in 2022 projected continued growth of more than 20 percent a year for U.S. river cruising through 2030, largely on the strength of the Mississippi River cruises.

River cruising “took off first in the European rivers, but it’s always been really built on American travelers,” said Charlie Robertson, an owner and chief executive of American Cruise Lines , the dominant operator on the Mississippi. Both American and Viking , a major player in Europe and Asia, are already booking Mississippi cruises into 2025, and building new ships to serve this market. Though the parent company of the third Mississippi cruise operator, American Queen Voyages, declared bankruptcy earlier this year, citing difficulties recovering from the effects of the pandemic, American Cruise Lines purchased all four paddle wheelers in its fleet.

“Demand’s not going anywhere but up,” Mr. Wellenkamp said. “Everybody wants to see the historic Main Street, and everybody wants to see this ecological icon Mark Twain wrote about.”

In Kimmswick, the new landing had local leaders dreaming of a return to the town’s roots as a key stop for Mississippi steamboats. After years spent building sandbag levees to protect Kimmswick — three major floods threatened the downtown since 2015 — and building a landing to accommodate 40-foot swings in the river’s flow, drought severe enough to threaten the town’s economic prospects seemed unthinkable.

“​​How can you be a river-facing city if you don’t have any riverboats?” said Phil Stang, Kimmswick’s mayor.

Powerfully unpredictable

The Mississippi basin extends to 32 states and two Canadian provinces, moving a staggering 600,000 cubic feet of water a second into the Gulf of Mexico. Even in its historic state, it could be powerfully unpredictable, with flows that oscillated by as much as 60 feet in the space of a season. T.S. Eliot called the river “a strong brown god — sullen, untamed and intractable.”

Today, much of the river has been remade as a maritime highway, with locks, levees and revetments designed to control its flow and stop floodwaters.

“When the river wasn’t leveed, it would flood 100 miles back into farmland,” said Lee Hendrix, who got his start as a deckhand on a towboat in 1972 and has spent the last 50 years working on the river . “Now, the levees don’t allow that.” As a result, the river’s swings are growing more intense. “It’s undeniable that it’s more volatile in terms of how rapidly it can rise and fall,” Mr. Hendrix said.

He spent last summer sharing Mississippi lore and trivia with passengers as the American Queen’s onboard “Riverlorian.” As the boat sailed past sandbars that went on for miles, he found himself grateful to be in a position with no responsibility for logistics. “There were a lot of docks we couldn’t get to,” he said.

Planning can blunt the impact of these disruptions — American Cruise Lines doesn’t schedule its tallest boats to sail the upper Mississippi, where sailing under some bridges during high water is impossible. The boats themselves are changing, too, to designs that can slip beneath low bridges, motor upstream against strong currents and get to shore in shallower waters. “Our basic design parameter is that if the tow boats can go, we can go,” said Mr. Robertson, the chief executive. “Because the Army Corps will move heaven and earth to allow the towing industry to keep moving.”

The U.S. Army Corps of Engineers runs patrol teams and a dredging operation to maintain a navigable channel at least 300 feet wide and 9 feet deep. In recent years, the Corps has added more structures along the riverbanks called “chevrons” that allow high water to better flush out sediment that blocks the channel. Nevertheless, drought conditions have extended seasons when dredging is required.

“While we’re dredging less, our crews are out there on the river for a longer time,” said Shawn Sullivan, the strategic planning coordinator for the Corps’ St. Louis district. “I don’t know what normal is anymore.”

Carefully timed trips

Carol Coletta leads Memphis River Parks Partnership , the nonprofit that manages Beale Street Landing. The group anticipates a $700,000 revenue shortfall from landings this fiscal year, and is looking for ways to modify a second landing that can welcome boats even when the river is at its lowest. “We have to anticipate that this could persist,” Ms. Coletta said, “and if it does persist, then we cannot count on boat dockings for revenue.”

For cities smaller than Memphis, the hit can be much deeper. “If you’re a town of 800 people and a boat of 250 shows up, you’re going to feel that in your economy,” said Mr. Wellenkamp, of the Cities and Towns Initiative. “We have cities that 20 percent of their economy is captured from the riverboats stopping in, and we have cities where 60 percent of the economy is captured from riverboats stopping in.”

Cindy Anderson, who owns the travel agency USA River Cruises, says she’s gotten more careful in advising customers when to visit the region. “We have people ask us, and I say, ‘Springtime is fabulous,’” she said. Vendors have shifted their offering, too. The whole Mississippi, from St. Paul to New Orleans, was a popular itinerary Ms. Anderson used to sell year round; now it’s only available for a few months in the summer.

“That’s a very long and expensive cruise to book if you have to cancel it,” she said.

Even as cruise traffic on the Mississippi has grown, Ms. Anderson says much of her business has shifted to the Columbia River, in the Pacific Northwest, where large dams and meltwater from high peaks modulate seasonal changes in flow.

“We don’t have any water issues on the Columbia River — it never closes down, it never floods,” she said.

Ms. Anderson compared the unpredictability of Mississippi River itineraries to European rivers, many of them crisscrossed by historic bridges that offer little clearance for cruises to pass when waters are high. There, operators often ferry passengers between segments of a trip on chartered buses. But, Ms. Anderson said, most guests will expect refunds for an itinerary full of transfers by what cruise operators often call “motor coach.”

“Because they didn’t really get a cruise, they got a bus trip,” she said.

Follow New York Times Travel on Instagram and sign up for our weekly Travel Dispatch newsletter to get expert tips on traveling smarter and inspiration for your next vacation. Dreaming up a future getaway or just armchair traveling? Check out our 52 Places to Go in 2024 .

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