What causes nausea and vomiting? How can they be prevented and treated? Learn about the various factors that can lead to these symptoms and the effective remedies available.

Understanding Nausea and Vomiting

Nausea and vomiting are common symptoms that can have a wide range of underlying causes, from pregnancy and motion sickness to gastrointestinal infections and medication side effects. While these symptoms can be unpleasant, there are various strategies and treatments that can help manage and prevent them.

Causes of Nausea and Vomiting

Nausea and vomiting can be triggered by a variety of factors, including:

• Pregnancy: Hormonal changes during pregnancy often lead to nausea and vomiting, particularly in the first trimester.
• Motion sickness: Disturbances in the inner ear can cause nausea and vomiting when traveling by car, boat, or airplane.
• Gastrointestinal infections: Viruses, bacteria, or parasites that infect the digestive system can result in nausea and vomiting.
• Medication side effects: Certain medications, such as chemotherapy drugs, can cause nausea and vomiting as a side effect.
• Migraine: Nausea and vomiting are common symptoms of migraine headaches.
• Intense pain: Severe pain, such as from an injury or surgery, can trigger nausea and vomiting.
• Food poisoning: Consuming contaminated food or beverages can lead to nausea, vomiting, and other gastrointestinal symptoms.
• Gallbladder disease: Problems with the gallbladder, such as gallstones, can cause nausea and vomiting.
• Emotional stress: High levels of stress and anxiety can contribute to nausea and vomiting.

Preventing and Treating Nausea and Vomiting

If you experience nausea or vomiting, there are several steps you can take to find relief:

1. Stay hydrated: Drink small, frequent sips of water or other clear fluids to prevent dehydration.
2. Eat bland, easy-to-digest foods: Stick to simple, low-fat foods like bananas, rice, applesauce, or toast until the nausea subsides.
3. Try over-the-counter medications: Medications like Dramamine or ginger supplements can help alleviate nausea and vomiting.
4. Practice relaxation techniques: Techniques like deep breathing, meditation, or progressive muscle relaxation can help reduce stress and nausea.
5. Use acupressure: Applying pressure to specific points on the body, such as the P-6 point on the wrist, can help relieve nausea and vomiting.
6. Seek medical attention: If nausea and vomiting persist or worsen, consult your healthcare provider to identify the underlying cause and receive appropriate treatment.

Acupressure for Nausea and Vomiting

Acupressure, a complementary therapy based on the principles of traditional Chinese medicine, can be an effective way to alleviate nausea and vomiting. One of the most commonly used acupressure points for these symptoms is the P-6 (or Neiguan) point, located on the inner wrist.

How to Locate and Use the P-6 Acupressure Point

1. Position your hand with your fingers pointing up and your palm facing you.
2. Place the three middle fingers of your other hand across your wrist, just below the wrist crease.
3. Place your thumb just below your index finger, in the space between the two large tendons you can feel.
4. Apply firm but gentle pressure to this point, moving your thumb in small circular motions for 2-3 minutes.
5. Repeat the process on the other wrist.

Remember to avoid using acupressure if the skin in the area is damaged or inflamed. Additionally, be sure to consult your healthcare provider if nausea and vomiting persist or worsen.

When to Seek Medical Attention

In most cases, nausea and vomiting can be managed with home remedies and over-the-counter medications. However, there are certain situations where it’s important to seek medical attention:

• Persistent or severe vomiting that leads to dehydration
• Vomiting accompanied by severe abdominal pain, high fever, or other concerning symptoms
• Nausea and vomiting that interfere with your ability to keep down fluids or medications
• Vomiting in young children, as it can indicate a more serious underlying condition

Your healthcare provider can help determine the underlying cause of your nausea and vomiting and provide appropriate treatment to help you find relief.

Conclusion

Nausea and vomiting can have a wide range of causes, from pregnancy and motion sickness to gastrointestinal infections and medication side effects. While these symptoms can be unpleasant, there are various strategies and treatments, such as staying hydrated, eating bland foods, and using acupressure, that can help manage and prevent them. If nausea and vomiting persist or worsen, it’s important to seek medical attention to identify and address the underlying cause.

Acupressure for Nausea and Vomiting

Time to Read:
About 2 minutes

This information explains how to use acupressure (AK-yoo-PREH-sher) to help with nausea and prevent vomiting. Nausea is feeling like you’re going to throw up. Vomiting is throwing up.

Acupressure is a kind of massage. It is based on the traditional Chinese medicine practice of acupuncture (AK-yoo-PUNK-cher). With acupressure, you put pressure on certain places on your body. These places are called acupoints (AK-yoo-poynts).

Pressing these acupoints can help your muscles relax and improve your blood flow. It can also help with many common side effects of chemotherapy, such as nausea and vomiting.

You can do acupressure at home by using your fingers to put pressure on different acupoints. Watch this video or follow the steps below to learn how to do acupressure.

This video will show you how to perform acupressure to help relieve nausea and vomiting.

Video Details

Pressure point P-6 is also called Neiguan (nay-gwann). It is found on your inner arm near your wrist. Doing acupressure on this point can help with nausea and prevent vomiting.

Do not do acupressure on this point if:

• The skin at or near the point is peeling or blistering.
• There is an open wound at or near the point.
• There is a rash at or near the point.
• There is redness, swelling, warmth, or pus at or near the point.

How to find pressure point P-6

To find pressure point P-6:

1. Position your hand so that your fingers are pointing up and your palm is facing you.
2. Place the first 3 fingers of your other hand across your wrist (see Figure 1). Your fingers should be placed just below your wrist crease (where your wrist bends).
3. Place your thumb just below your index (pointer) finger. Remove the 3 fingers from your wrist but keep your thumb on that spot (see Figure 2). Use your thumb to press down on the spot. You should be able to feel 2 large tendons (tissue that connects muscles to bones) in between your thumb. This spot in between the 2 tendons is pressure point P-6.
   • Once you have found the pressure point, you can relax your hand and keep it in a comfortable position.

Figure 1. Placing 3 fingers across wrist to measure where to put thumb

Figure 2. Placing thumb on point below index finger

1. Press down on this point with your thumb. Move your thumb in a circle while applying pressure. You can move it in clockwise (to the right) or counterclockwise (to the left) circles. Do this for 2 to 3 minutes.
   • Some people may find it hard to use their thumb. You can use your index finger instead.
   • Be firm when applying pressure, but do not press so hard that it hurts. You may feel some aching or tenderness, but it should not be painful. If you feel any pain, you’re pressing down too hard.
2. Repeat steps 1 to 4 on your other wrist.

You can do acupressure on this point a few times a day until your symptoms improve.

Acupressure is a complementary therapy. Complementary therapies are treatments you can use along with your cancer treatments. They can help ease your symptoms.

To learn about other complementary therapies, call MSK’s Integrative Medicine Service at 646-449-1010 or visit www.mskcc.org/integrativemedicine.

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Last Updated

Thursday, June 23, 2022

Nausea and vomiting: Causes, treatments, and tips

Nausea, vomiting, or both can occur with migraine, motion sickness, gastrointestinal infections, medication use, and other factors. Treatment will depend on the cause, but some over-the-counter drugs can help manage symptoms.

Nausea and vomiting do not constitute a standalone condition. However, there are many possible causes of these symptoms, including motion sickness, infections, migraine, food poisoning, gallbladder disease, intense pain, surgery, pregnancy, indigestion, and emotional stress.

Vomiting in young children is common. Causes include reflux, but it can also indicate a more serious problem, such as an intestinal obstruction or meningitis.

In this article, learn more about the causes of nausea and vomiting and what to do if they happen.

There are many possible causes of nausea and vomiting, including those below:

Pregnancy

Nausea and vomiting are common during pregnancy due to hormonal changes. People often call this morning sickness, although it can happen at any time of the day.

The symptoms usually start within the first 9 weeks of pregnancy and often disappear by week 14. However, they can sometimes persist throughout the pregnancy.

Severe nausea and vomiting, called hyperemesis gravidarum, affects about 3% of pregnancies. If there is a risk of dehydration, it may be necessary to seek medical treatment and spend time in the hospital.

Here, get some tips on minimizing morning sickness.

Central nervous system

Many diseases and conditions that affect the central nervous system (CNS) have nausea as a symptom.

Examples include:

• migraine
• seizures
• tumors
• stroke
• head trauma
• meningitis
• hydrocephalus

Experts do not know why many CNS problems cause nausea and vomiting.

Ear problems

Related to CNS disorders are inner ear (vestibular) problems, which can affect a person’s sense of balance. This effect can lead to vertigo, nausea, and vomiting.

Conditions that affect the inner ear include:

• Motion sickness: Some modes of transport and fairground rides can trigger this.
• Labyrinthitis: This inner ear infection usually occurs due to a virus.
• Benign positional vertigo: A small movement, such as moving the head, can trigger a spinning sensation.
• Ménière’s disease: This long-term ear condition can affect a person’s balance and cause dizziness, vertigo, tinnitus, and hearing loss.

Pelvic and abdominal conditions

Many pelvic and abdominal conditions have nausea as a symptom. These conditions can affect the gastrointestinal tract, the reproductive system, the liver, and other parts of the body, depending on the cause.

The following are just a few examples:

• hepatitis
• pancreatitis
• obstruction or irritation in the digestive system
• gastroesophageal reflux disease (GERD)
• kidney disease
• gallbladder disease
• infections, such as gastroenteritis
• constipation
• menstruation

Anxiety, depression, and stress

Psychological conditions that can induce nausea include:

• anxiety and related disorders
• depression
• anorexia nervosa
• bulimia nervosa

Alongside nausea, anxiety can lead to lightheadedness, diarrhea, and frequent urination.

Cancer

Some types of cancer can cause nausea and vomiting. These include:

• a brain tumor
• cancer that causes a blockage to the bowel
• cancer anywhere in the gastrointestinal system
• a tumor in the appendix or pancreas
• lung cancer
• ovarian cancer

Cancer therapy

Nausea and vomiting are also common side effects of cancer therapy.

Medication can help manage symptoms and prevent complications. Possible complications include a loss of appetite, damage to the esophagus, dehydration, malnutrition, and a reopening of surgical incisions.

The cancer treatments that most commonly cause nausea are:

Chemotherapy

The severity of symptoms will depend on various factors, including the type and dosage of treatment and how the person’s body responds to it.

Radiation therapy

The risk is higher when treatment involves the brain, liver, or gastrointestinal tract. It also increases with higher doses.

People may have an increased risk of severe symptoms from chemotherapy or radiation therapy if they:

• experienced severe and frequent nausea and vomiting during previous treatment
• are female
• are under 50 years of age
• have constipation
• are taking certain medications, such as opioids
• have anxiety
• have an infection
• have kidney disease
• have an electrolyte or fluid imbalance in their body

Cyclical vomiting syndrome

This rare condition usually occurs in children, but can also affect adults. The individual will have episodes of nausea and vomiting for no clear reason. They will then feel well but may have another episode, perhaps a month later.

The cause is unclear, but there may be a link with migraine.

Other possible causes include:

• stress or anxiety
• dietary factors
• recurrent infections
• menstruation
• excessive physical exercise
• a lack of sleep

In children

Common causes of vomiting in young children include:

• reflux
• minor intestinal infections
• chest, urine, or other infections
• a food allergy or intolerance
• food poisoning
• some serious conditions, such as meningitis and appendicitis

People often link teething with vomiting, but experts do not consider there to be a link.

Nausea and vomiting are usually temporary symptoms that go away on their own, but they can sometimes indicate a more serious condition.

It is important to seek medical advice if the following symptoms also occur:

• severe stomach pain
• blood in the vomit
• vomiting that lasts longer than 24 hours
• a severe headache
• a stiff neck
• dehydration

Treating the underlying cause may also relieve nausea and vomiting.

Young children

Vomiting is common in infants and young children, and it is often not a cause for concern.

However, parents or caregivers should seek medical attention if vomiting continues for more than a day or two, or the following symptoms are present:

• signs of dehydration, such as dry lips, sunken eyes, and infrequent urination
• frequent and forceful vomiting
• green or greenish-yellow vomit
• blood in vomit or stools
• refusing to feed
• any other concerning symptoms

The treatment for nausea and vomiting will depend on the cause, but some medications — known as antiemetics — can help manage the symptoms.

There are several over-the-counter options. If these are not effective, a doctor may prescribe a stronger drug.

People should take care when using any medications and always:

• read the directions on the package
• follow the instructions regarding how much to take and when
• check with a doctor before using any new medication
• seek medical advice if they cannot keep the medication down

Antihistamines

Antihistamines may relieve the symptoms of nausea when it results from motion sickness, migraine, or vertigo.

Examples include dimenhydrinate (Dramamine) and meclizine hydrochloride (Dramamine Less Drowsy).

To avoid motion sickness when traveling, it is best to take these drugs just before the trip.

Side effects may include:

• drowsiness
• dry eyes
• dry mouth

People who take sedatives, muscle relaxants, or sleeping pills should check with their doctor before using antihistamines.

Other remedies

There are also treatments specific to:

• morning sickness
• sickness due to cancer treatment
• gastrointestinal problems due to diabetes and other conditions
• cyclical vomiting syndrome

A doctor can advise on suitable options.

Herbal and alternative remedies

Some people use alternative remedies, such as:

• acupuncture
• ginger powder or tea
• vitamin B-6

It is not always possible to avoid nausea and vomiting, but people may be able to prevent or manage symptoms by:

• drinking plenty of water, taking sips, if necessary, to prevent vomiting
• drinking ginger or peppermint tea
• eating regular meals and avoiding heavy, greasy food
• letting in some fresh, cool air
• sitting upright after eating to avoid reflux
• avoiding tight clothing
• washing the hands frequently to reduce the risk of infections
• seeing a doctor if nausea and vomiting are frequent and unexplained

Get some more tips here on avoiding nausea.

Nausea and vomiting are common symptoms of many diseases and conditions. These symptoms often go away without treatment, but various options can help prevent or manage them.

Anyone with nausea and vomiting that are severe, persistent, cause dehydration, or occur alongside additional symptoms should see a doctor.

Discussion, answers to questions

Professor Erdes S.I.: – Questions have already been received, and some of them are addressed specifically to you, Arkady Alexandrovich. We would love to hear the answers to them.

Professor Sheptulin A.A.: – Question: “Why do such patients have nausea and vomiting in the morning? Is it necessary to prescribe proton pump inhibitors and antacids in the morning or in the evening to stop morning vomiting?

Morning vomiting is not Barrett’s esophagus or gastroesophageal reflux disease. Nausea and vomiting in the morning in the patient I spoke about in my speech was not associated with gastroesophageal reflux disease, but most likely with severe alcoholic gastritis. For patients with alcoholic gastritis, morning vomiting of mucus is an almost pathognomonic symptom.

Question: “What is the partial contribution of the violation of the secretory function of the stomach and the violation of its motor function in the genesis of GERD?”.

Of course, the biggest contribution. First, the slowdown in gastric evacuation contributes to an increase in intragastric pressure, and this in itself provokes reflux. Well, the final effect on the mucous membrane of the esophagus, of course, has a high secretion of hydrochloric acid. We do pH monitoring in order to determine the duration of this decline.

Question: “Have you met in your practice an increase in the incidence of community-acquired pneumonia with long-term continuous use of proton pump inhibitors?”.

I have not met. And according to the literature, there is no increase in the incidence of community-acquired pneumonia with the use of proton pump inhibitors. There was a lot of work on this subject, and this issue is already closed.

Question: “Which could be more effective for preventing Barrett’s esophagus: taking proton pump inhibitors for many years or stopping alcoholism?”

I think it’s both, in this case, because the cessation of alcoholism contributes to the normalization of motor skills and the improvement of the protective barrier of the mucous membrane of the esophagus and stomach.

Question: “What determines the risk of malignancy of the esophagus more: the size of dysplasia foci or the size of alcoholization?”.

Alcoholism itself is not a risk factor for esophageal cancer. The only thing is that, perhaps, a patient with us drinks some toxic liquids and so on, which in themselves damage. The damaging factor is the intake of very hot drinks. For the esophagus, this is really very serious. I think the size of the lesions and the dysplasia and lesions in Barrett’s esophagus play a big role. I will give one example. We had a patient, by the way, the surgeon himself, who underwent a gastrectomy, and gastrectomy always leads to subsequent bile reflux. And he had a segment of Barrett’s esophagus, which developed, was about 17 cm long. Against this background, he had multifocal dysplasia. And so the oncologists there very seriously resolved the question: what to do in such a situation.

Professor Erdes SI: – Question: “What are the first steps in examining young children with suspected reflux esophagitis? What are the prospects for the safe treatment of this pathology in this group of children?

Let me mark some boundaries. If we mean children of the first year of life, then it is known that the equivalents of reflux or reflux esophagitis are regurgitation and regurgitation. And this well-known fact tends to decrease by the year. And if this is not pathological regurgitation, not pathological regurgitation, and the symptoms of this patient as he grows up, his age increases, decreases in the first year of life, then we can regard this situation as not disturbing the attending physician.

If, on the contrary, the symptoms are growing, and you have reasonable grounds to refer this patient for a more in-depth examination, and suspect, as you already understand, possibly a congenital pathology of the esophagus, then in this situation, the sooner you refer this patient for examination surgeons, of course, and these issues will be resolved, so much the better. Therefore, it is not possible to speak unequivocally about the prospects for safe treatment in this group of pathologies, because these are two diametrically opposite groups of pathologies with the so-called physiological reflux, which will decrease.

And today there are international recommendations that quite clearly prescribe the appropriate activities. I invite you to those symposiums that will be held now as part of the Congress of Russian Pediatricians. And I will have a report on Saturday at the session, just devoted to international recommendations for the management of gastroesophageal reflux disease in children of different ages. And there I will touch on the features of international approaches to the management of this group of patients.

But to be brief, I will say that this is, first of all, non-drug treatment – these are dietary recommendations, including recommendations on the use of special thickening mixtures and so on. This will probably be the answer to your question about the safe treatment of this pathology in this age group of patients.

Q: How often do these young patients with Barrett’s esophagus have a history of chronic constipation?

According to the available literature, the presence of constipation is not considered a significant risk factor or a common comorbidity in patients with gastroesophageal reflux disease with reflux esophagitis and Barrett’s esophagus, which, fortunately, is still rare in the population.

Question: Is chronic constipation a contributing factor to duodenogastric reflux, one of the key risk factors for gastroesophageal reflux disease?

You know, in the international and domestic literature there are no such representative statistically reliable studies on the relationship between these two factors. But to a greater extent, I can say, based on my experience, that yes, perhaps, a feature of the gastroduodenal and general pathology of the gastrointestinal tract in children is its combined nature. But it is very difficult today to clearly and reliably identify the points of relationships between intestinal pathology, in this case, dysmotility, and whether this will be a risk factor for reflux disease. Although we certainly understand that the dysmotility seems to be generalized.

Candidate of Medical Sciences Lapina T.L.: – Question: “Should I start eliminating reflux symptoms immediately with proton pump inhibitors, or can I start with antacids or alginates?”.

If we are talking about gastroesophageal reflux disease, that is, situations where the symptoms of reflux worsen the quality of life of patients, of course, it is necessary to start treatment with proton pump inhibitors. This is a very interesting question, and it was the one that was put at the center of, in my opinion, the first very serious conference that was devoted to the discussion of evidence-based medicine for gastroesophageal reflux disease. This is the Genval Conference 1998 years. It was then that as the correct algorithm for managing patients with gastroesophageal reflux disease in any of its forms, it was recommended to start treatment with proton pump inhibitors. And antacids, of course, should be considered as auxiliary drugs for the treatment of gastroesophageal reflux disease.

Question: “Can we treat patients with reflux disease if they need to be treated for 260 weeks?”.

It is clear that the author of this question is referring to the study that I described in my lecture, in which patients with reflux disease were followed for five years taking the proton pump inhibitor Rabeprazole. It seems to me that here, perhaps, it is necessary to say that we do not believe that statins are the wrong group of drugs, because we prescribe stanins for the treatment of hyperlipidemia for life. And we believe that this is a very correct group of drugs.

Do we give aspirin for three days for atrial fibrillation? It seems to me that no, we prescribe aspirin for a long time. We treat hypertension for four weeks, and after that we say: “Goodbye, patient”? Naturally, proton pump inhibitors are a pathogenetically justified treatment for gastroesophageal reflux disease. Perhaps brilliant minds will give us a pill that allows you to restore the proteins of intercellular contacts of the cells of the squamous non-keratinized epithelium of the esophagus. Maybe then we will treat gastroesophageal reflux disease in a different way. But even in the project, I have not seen such drugs that have such a topical, targeted effect on gastroesophageal reflux disease.

Professor Erdes S.I.: – Question: “What is your opinion on the advisability of treatment with proton pump inhibitors alone, or is it necessary to add antacids, prokinetics and other drugs in the management of such patients?”.

In this case, I would like to clarify that if we are talking about the management of patients (be it a child or adolescent) with gastroesophageal reflux disease, or we are talking about the management of a patient already with Barrett’s esophagus, it should be understood that these are completely different things. Management of a patient with gastroesophageal reflux disease according to international recommendations involves long-term administration of proton pump inhibitors.

And today there is a very convincing and extensive evidence base for the safety of long-term use. Time interval – these were studies from two to eleven years in isolated cases. That is, the average duration of taking inhibitors was about 6.5 years. If we are talking about reflux disease, then we must say that this is basic therapy. As for the other groups of drugs that I mentioned, there is no representative, evidence base for them. But my clinical experience and the data that we have indicate the exceptional importance in the pediatric population, in children, of prescribing drugs that affect motility.

We have shown that the most pronounced, most clinical manifest forms, I mean erosive reflux disease, required not only higher doses of inhibitors, but also the appointment of concomitant therapy with prokinetic drugs that affect motility. And if we are talking about the management of patients with Barrett’s esophagus, it should be emphasized that there are no separate international recommendations regarding the management of children with this pathology in world practice today. And everywhere it is indicated that such patients (usually adolescents) are subject to management in accordance with international guidelines for the management of adult patients.

Question: “What is the morphological form of a malignant tumor?”

It has been mentioned many times – this is adenocarcinoma of the esophagus.

Candidate of Medical Sciences Lapina T.L.: – Question: “Is it necessary to prescribe proton pump inhibitors to a patient with bile reflux, or is it better to prescribe a prokinetic?”.

When bile reflux is proven, it is usually a combination of acid reflux and bile reflux. Proton pump inhibitors also help treat bile reflux because they reduce gastric secretions. There is one very ingenious Japanese study that needs to be studied better – this is an experimental work on mice, where they performed a special operation on mice in order to provoke reflux disease through bile reflux.

And, very interestingly, they tried to apply Rabeprazole to these mice. And, surprisingly, this drug stopped the phenomenon of esophagitis caused by this surgically induced bile reflux in the experiment. Of course, when it comes to the presence of bile reflux, we prescribe prokinetics, we think about prescribing alginates, prescribing antacids. But nevertheless, no one disputes the importance of proton pump inhibitors either.

Question: “Will GERD occur in the presence of hypersecretion of the stomach, but in the absence of reflux?”

I don’t think it will.

Question: “GERD and atrophic gastritis: are there any differences in therapy?”

From the point of view of epidemiologists, and they operate with large numbers and populations, in a population where there are many patients with GERD, there are few patients with atrophic gastritis. In a population where there are many patients with atrophic gastritis, on the contrary, there will be few patients with gastroesophageal reflux disease. That is, in one patient, we most likely will not find real atrophic gastritis of the body of the stomach and clinically pronounced gastroesophageal reflux disease.

It is clear that if a patient comes to us, for example, with initial symptoms of atrophy of the antrum of the stomach and infection with pyloric Helicobacter, we will first of all carry out eradication for him, and then we will calmly treat him with proton pump inhibitors against the background without infection with pyloric Helicobacter as it should be in gastroesophageal reflux disease.

Professor Erdes S.I.: – I hope that we managed to attract the attention of the audience. It was the first and not so frequent experience when both pediatricians and internists met in the same studio, especially to discuss such a seemingly rare, but very formidable pathology. I hope we were of interest to you. We look forward to your follow-up questions, of course, none of them will remain unanswered. Thank you for your attention.

Nausea in VR – Offtopic on vc.ru

How developers deceive the human brain.

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Virtual reality games create an immersive effect that is incomparable with traditional ones, but the technology still has many problems: it requires a lot of computing resources, and VR devices are not yet perfect. Difficulties for developers are also created by the characteristics of the human body. Particularly in virtual reality, people may experience nausea.

Developers of VR games see this problem differently: they have different views on its causes and how to deal with them. DTF spoke with Denis Tambovtsev, an expert on interaction systems in VR/AR, Alexander Lukichev, head of product development at DVR, Rustam Mirzakhmedov, co-founder of Beagle Games studio, as well as Mikhail Shkaredny, co-founder of MiroWin VR, and Vadim Kaipov, director of development at Fair Games Studio, about why, in their opinion, nausea occurs in virtual reality and what tricks they use to get rid of it.

Causes of nausea

Virtual reality “deceives” the brain. The position and movement of a person in space is fixed by the vestibular apparatus located in the inner ear. It is this organ that transmits information to the brain about what is happening with the body at the moment. Together with the information received by other senses (in particular, the eyes), the brain determines what the rest of the body needs to do and feel.

In virtual reality, the indicators of the vestibular apparatus and organs of vision differ, because a person sees movement, but the body remains at rest. The brain perceives visual information as a hallucination that can be experienced with poisoning, and therefore causes nausea to cleanse the body. This phenomenon is called kinetosis. However, not everything is so simple – the reasons may be not only the natural properties of the organism.

The Elder Scrolls V: Skyrim VR

Denis Tambovtsev, an expert on interaction systems in VR / AR, for example, divides the causes of kinetosis into three blocks: hardware, software and individual aspects.

In terms of hardware, the current solutions are far ahead of their counterparts from the nineties. Now, with a properly built interaction system, you can achieve excellent results in resolving the issue for most users. But there is also something to strive for – response time, resolution, field of view, pupil tracking, weight of the device, general ease of use, and the like – all this can affect the situation with motion sickness to one degree or another. A simple example is the poor ergonomics of some “no-name” glasses: if they do not sit well on the head or are simply poorly fixed, then with a sharp movement, the image may shift relative to the eyes, which can ultimately “sick” the user.

At the same time, the overwhelming number of problems with motion sickness in virtual reality is associated with a poorly built system of interaction and movement in VR projects. So it’s a bad design problem. Interception of a virtual camera, for example, in cut scenes or using the shaking effect, a control system in which there is no synchronization between the real position of the user and the virtual one (in reality, a person is sitting, but in VR he moves to the left or turns around using the keyboard or gamepad) and many others examples. Unfortunately, despite the already quite large number of different guidelines for building a comfortable experience in a virtual environment, many developers repeat the same mistakes.

Individual aspects are beyond the control of the makers of VR glasses and games. There are individual characteristics – diseases associated with impaired coordination of movement, the usual overwork, lack of sleep, the presence of influenza – aspects that cannot be controlled on the developer’s side, but which, as it seems, can increase the effect of motion sickness. There is also simply a predisposition to the usual motion sickness. But developers, for their part, must do everything possible to create the most comfortable user experience, and the existing expertise and tools are enough for this.

Denis Tambovtsev, expert on interaction systems in VR/AR

Doom VFR

The head of product development in DVR, Alexander Lukichev, in turn, also identifies several main reasons for the feeling of nausea in virtual reality. Although, in his opinion, the physiological characteristics of the body are the basis: if the developers of a VR game do everything in their power, most people will not experience discomfort.

The first reason is the movement of the gaze (camera) without the knowledge of the user. Namely: the position and rotation of the camera is not synchronized with the rotations and position of the observer’s head. This is the most common cause of dizziness and nausea. It is this technique that the creators of the roller coaster consciously use, limiting the length of the session.

The second reason is high latency (delay in the program’s response to user actions). And this is not only related to the number of graphics rendering frames, but also precisely with the accuracy and speed of the sensors, receiving and processing data from their contours. It is possible that even at high FPS, there is a chance of experiencing dizziness if the movement of the graphics lags behind the physical movement of the user’s head. This is the so-called “gum” mode.

Alexander Lukichev, Head of Product Development at DVR

In addition, Lukichev identifies three more mistakes that developers make and which, in theory, can lead to player nausea.

• The discrepancy between the scales of the physical world and the virtual one. If the player is a giant or a midget in VR, then the likelihood of dizziness and nausea is very high. This is an unusual (stressful) state for the user to which the body reacts in this way.
• Too abrupt movement (animation of space) is also likely to lead to nausea.
• Incorrect “distortion” of space that the human eye is used to seeing

Co-founder of Beagle Games, which develops Treasure Hunter VR, Rustam Mirzakhmedov, in addition to the peculiarities of the human body and FPS drawdowns, points to another reason for kinetosis in virtual reality – the insufficient accuracy of the IMU sensors that measure the position of the device in space.

Nausea occurs due to a mismatch in the response in the virtual world to head rotation in the real world, this can be affected by the accuracy of the sensors (IMU). So, for example, when testing the same game, on the same smartphone and all other things being equal – in the cardboard mode, the motion sickness is much faster than when using the Gear VR build. The latter uses its own Oculus IMU built into the glasses. On desktop systems (Rift and Vive), in addition to tracking the rotation of the head, its position is also monitored, due to which the response discrepancy practically disappears and you can stay in the helmet for quite a long time.

Rustam Mirzakhmedov, co-founder of Beagle Games

Mikhail Shkaredny, co-founder of MiroWin VR, which released Guns & Stories: Bulletproof VR believes that only the human body is to blame for kinetosis, and technology has nothing to do with it. At the same time, you can get used to the dissonance in virtual reality.

If you, living on land, get on a boat rocking on the waves, you begin to feel yourself in an alien environment. It is very unusual for you, but the body dictates its usual norms. This is the main dissonance. In virtual reality, we can see how we move, but in fact we remain standing on the ground. However, seasoned guys from the archipelagos have been boating since childhood. For them, this environment is quite familiar. No, technology has nothing to do with it. The body thinks it is being deceived. And he’s right, but he gets used to it.

Mikhail Shkaredny, co-founder of MiroWin VR

Fair Games Studio development director Vadim Kaipov, in addition to the obvious discrepancy between the visible and the perceived person, also points to such causes of kinetosis as a large number of objects in virtual reality, as well as lags that occur due to the low resolution of the image in glasses.

Prevalence of the problem

According to Unity, 40% of people in VR experience kinetosis. At the same time, the results of a Columbia University study suggest that 83% of people experience motion sickness in virtual reality. One of the developers of the Oculus Rift helmet, Michael Abrash, in turn, said that 60% of the population are able to adapt to pitching and only 20% of people always experience it.

Lone Echo

That is, the data differ, as do the views of the developers themselves. So, according to Alexander Lukichev, 10% of users experience discomfort when using virtual reality glasses for the first time. With repeated “immersion”, more than 5% of them feel normal. Rejection of VR, up to vomiting and loss of consciousness, according to Lukichev, occurs only in 1% of players.

Vadim Kaipov, in turn, believes that a large number of people are affected by kinetosis.

Huge number, this shows experience at exhibitions. When we invite passers-by to play our game, they say that they have already tried VR at another booth and they need time to move away from it. We have to explain each time that most likely they were moved inside the glasses, which is why they are sick, and that we don’t do that. In the end, they agree to try it, and then they are surprised that in VR you can not feel sick and that you can fully enjoy the gameplay and immersion.

Vadim Kaipov, Development Director, Fair Games Studio

In general, the developers in this question mainly refer to their own experience and indicate that everything depends on the specific game. Denis Tambovtsev, for example, notes that he almost never met people who would be swayed in games “where the system of control and movement in virtual space is well built.”

However, MiroWin VR believes that this is a matter of habit.

The more a person is subject to bouts of seasickness, the more difficult it will be for him to get used to, but again, this is a matter of training. As a VR developer told me: “Virtual reality should be taken for 20 minutes every day. ” He is right. With practice, all discomfort will disappear, no matter how contradictory to human nature mechanics may be.

Mikhail Shkaredny, co-founder of MiroWin VR

Control methods

To get rid of the feeling of nausea, the developers resort to a variety of tricks. Someone believes that if you remove the movement in the virtual space, then the kinetosis will disappear by itself; someone builds scenes in a certain way, focusing the player’s attention on some specific objects, and someone deftly plays with lighting and effects.

Denis Tambovtsev, Alexander Lukichev and Rustam Mirzakhmedov agree that it is necessary to give the player a “binding” in space – to make a static foreground, like an airplane cockpit, a helmet or even a nose.

EVE: Valkyrie

In addition, the developers recommend paying great attention to the movement of the user in the virtual space. Vadim Kaipov, for example, advises completely taking away the player’s ability to walk, focusing on transmitting his own movements (which HTC Vive can help with) or using teleportation. Denis Tambovtsev considers this method one of the most effective in the fight against kinetosis.

At the moment, this is one of the most effective options to solve the problem of motion sickness when creating a motion control system. It is all the more interesting that there are projects where teleportation becomes a feature in terms of game mechanics and is no longer read as some kind of half measure that compensates for the absence of a classic movement.

Denis Tambovtsev, expert on interaction systems in VR/AR

Mikhail Shkaredny, while indicating that the movement should not be abrupt, otherwise all the advantages of teleportation in the fight against nausea are leveled.

First of all, it is necessary that nothing happens abruptly or instantly. Human memory “knows” the laws of physics, they must be followed. If a person, in reality, standing still, suddenly flies to the side in VR, he will feel a tremor in his knees and, in general, bad sensations. It is necessary to balance between realism and plausibility (many of these concepts are confused).

Mikhail Shkaredny, co-founder of MiroWin VR

Denis Tambovtsev also notes separately the games in which the character’s hands are present. With proper implementation of this mechanics, it can reduce motion sickness. He notes that the use of hands can be justified, for example, in a space setting where the player has to push off surfaces, as in Lone Echo.

Games that managed to overcome the feeling of nausea

Different projects affect a person in different ways. Some developers are particularly focused on combating kinetz. This is how Rustam Mirzakhmedov and Denis Tambovtsev celebrate the success of Eagle Flight from Ubisoft in this field, although they point to different points. Tambovtsev, for example, talks about the narrowing of the visible area during accelerations and turns, and Mirzakhmedov believes that the “eagle simulator” does not cause nausea due to the bird’s large static beak.

Eagle Flight

In general, an expert on interaction systems in VR / AR notes that “popular Oculus exclusives and top Steam VR projects” cope well with nausea.

Interestingly, this cannot be said about Sony – in PSVR exclusives, you can not always find comfortable movement in space, although this applies more to the very first releases for the platform.

Denis Tambovtsev, expert on interaction systems in VR/AR

According to Alexander Lukichev, the developers of The Climb for Oculus CV1, Serious Sam and EVE Gunjack for HTC Vive, and Until Dawn for PSVR succeeded in the fight against kinetosis.

Until Dawn: Rush of Blood

However, not everyone believes that games should fight nausea at all.

A VR game doesn’t need to deal with this problem. Developers only have to remove the discomfort of interaction. In fact, the more loyal the game is to the user, the less it will be able to give him.