Mal de Débarquement Syndrome, French for “sickness of disembarkment,” is a disorder of the central nervous system characterized by a persistent and subjective sensation of motion, which typically begins after a period of travel on water, in the air, or on land. The feeling is not one of true vertigo (a spinning sensation), but rather a constant, internal feeling of rocking, swaying, bobbing, or tumbling, as if one is still on the boat or in the vehicle.

A key and paradoxical feature of MdDS is that the symptoms are often temporarily relieved by re-exposure to passive motion. An individual who feels they are constantly rocking while sitting still may feel perfectly normal and stable while driving a car. This temporary relief with motion is a hallmark sign that helps differentiate MdDS from many other balance disorders.

To understand what might be happening, it is helpful to use an analogy. Think of your brain’s balance system as a highly sophisticated gyroscope with an internal “noise-canceling” feature. When you get on a cruise ship, your brain is bombarded with new, constant, and predictable motion signals. To help you adapt and function, your brain’s gyroscope creates an “internal model” of this rocking motion and learns to cancel it out. This is why you eventually get your “sea legs” and can walk around the ship without feeling seasick.

In MdDS, it is as if the gyroscope gets stuck. The brain’s noise-canceling program fails to re-adapt and keeps running, continuing to generate an internal signal that cancels out a motion that is no longer there. This creates the phantom, persistent sensation of rocking and swaying.

In my experience, patients with MdDS often describe a strange, persistent “rocking” feeling like they’re on a boat, even while sitting still. Many say it’s worse in quiet, still environments and improves slightly when they’re moving.

The exact cause of MdDS remains unclear, but research suggests it stems from a failure of the brain to readapt to stable ground after prolonged exposure to passive motion.

The leading theory is one of maladaptation. As described in the analogy above, the brain successfully adapts to a new motion environment (like a boat) but then fails to readapt back to a stable environment once the motion has stopped. The internal “neural pattern” of the motion gets stuck in a persistent loop.

Researchers believe this may involve a dysfunction in the vestibulo-ocular reflex (VOR), the pathway that coordinates eye and head movements to keep vision stable. Other areas of the brain implicated in this process include the cerebellum (which coordinates balance), the brainstem, and areas of the cortex responsible for processing motion and spatial orientation. Essentially, the brain’s ability to recalibrate its sense of “stillness” is impaired.

When a patient tells me they feel like they’re rocking even after a trip ended days ago and standard exams are normal, I immediately consider MdDS. It’s frequently overlooked, especially in primary care.

A person develops MdDS when their brain’s adaptive mechanisms fail to reset after a period of motion, or in some cases, for no apparent reason at all. The condition is broadly classified into two onset types.

1. Motion-Triggered MdDS (The Classic Form)

This is the most common presentation. The symptoms begin within 48 hours of disembarking from a period of prolonged, passive motion. While a long cruise is the most famous trigger, it can be caused by many different stimuli:

• Sea travel (cruises, boat trips, ferry rides)
• Air travel
• Long car or train journeys
• Even less common triggers like using treadmills or sleeping on waterbeds have been reported.

2. Spontaneous or Non-Motion-Triggered MdDS

In a significant minority of cases, individuals develop the exact same symptoms of rocking and swaying without any preceding motion event. This spontaneous onset can be even more baffling and distressing, as there is no clear trigger to point to.

Risk Factors and Demographics

While anyone can develop MdDS, it has a very distinct demographic profile.

• Gender: The condition overwhelmingly affects women more than men (estimates are around 80-90%).
• Age: It most commonly affects individuals in middle age, with a peak onset between the ages of 40 and 50.
• History of Migraine: There is a very high correlation between MdDS and a personal or family history of migraine headaches, suggesting a possible shared predisposition to sensory processing abnormalities in the brain.

I’ve seen MdDS most often in women after cruises or flights. The brain usually reorients within hours or days, but in MdDS, it’s as if the balance system gets “stuck in motion mode” and can’t reset.

MdDS is marked by a persistent internal sensation of movement, often described as rocking, bobbing, or swaying.

This core symptom is accompanied by a very specific set of characteristics that help in its diagnosis.

• The sensation is constant while the person is sitting or standing.
• The sensation is typically absent when the person is in passive motion, such as riding in a car.
• The sensation is usually not present, or is at least significantly reduced, upon first waking in the morning, but often begins as soon as the person gets out of bed.

In addition to the phantom motion, individuals with MdDS often experience a range of other debilitating symptoms:

• “Brain fog,” difficulty concentrating, and problems with short-term memory.
• Profound fatigue and exhaustion.
• Anxiety, and in some cases, depression, which is often a direct consequence of the chronic, disorienting sensation and the frustration of being misdiagnosed.
• Headaches, often with migraine-like features.
• Visual sensitivity, where busy patterns, scrolling on a computer screen, or being in a crowded supermarket can worsen symptoms.
• Ear symptoms like feeling full or tinnitus (ringing in the ears).

What makes MdDS unique is that patients often feel better while moving, like in a car, and worse when still. This paradox is a key clue that separates it from most other balance disorders.

Diagnosing MdDS can be an extremely difficult and invalidating journey for patients. Because it is rare and its symptoms are subjective, many healthcare providers are unfamiliar with it. Patients are often told their symptoms are due to anxiety, menopause, or are simply “in their head.”

The key diagnostic features are:

• The presence of a characteristic, non-spinning swing feel.
• Symptom onset within 48 hours of a motion event (for the classic type).
• The temporary disappearance of symptoms with re-exposure to passive motion (e.g., driving).
• Symptoms that persist for over a month.
• A normal neurological exam and normal vestibular test results.

A crucial part of the diagnostic process is ruling out other conditions that can cause dizziness or imbalance. A typical workup includes:

• Brain MRI: To rule out a stroke, multiple sclerosis, or a brain tumor.
• Vestibular Function Tests: A battery of tests, such as a videonystagmography (VNG) or rotational chair test, to check the function of the inner ear balance system. A hallmark of MdDS is that these tests are typically completely normal, which can add to a patient’s frustration but is actually a key piece of the diagnostic puzzle.

I’ve seen patients spend months chasing answers before getting the right diagnosis. Once we recognize the symptom pattern, it’s often a relief to finally give it a name, even if treatment takes time.

There is no universally effective cure, but many patients respond to a combination of therapies.

1. Vestibular and Neurological Rehabilitation

• Standard vestibular rehabilitation therapy (VRT) that is used for inner ear problems is often not effective for MdDS and can sometimes worsen symptoms.
• Some specialized centers have developed protocols using optokinetic stimulation. This involves having the patient watch large, moving visual patterns while their head is gently tilted. The theory is that this visual input can help the brain’s “gyroscope” to recalibrate and break the faulty motion loop.

2. Medications

There is no single medication that has proven to be effective for everyone with MdDS. Medications that are sometimes tried are typically those that work on the central nervous system to calm down nerve activity. These include:

• Benzodiazepines, like clonazepam or diazepam.
• Certain antidepressants, such as amitriptyline or SSRIs/SNRIs.
• Medications used for migraine prevention.

3. Lifestyle and Coping Strategies

For many, learning to manage symptoms is the most important part of management.

• Trigger Management: Identifying and minimizing exposure to things that worsen symptoms, such as fluorescent lighting, crowded stores, or busy visual patterns.
• Stress Reduction: Mindfulness, meditation, and gentle yoga to manage the anxiety that exacerbates the condition.
• Distraction: Keeping the brain actively engaged in a complex mental task can help to reduce the perception of the phantom motion.
• Support: This is perhaps the most critical element. Connecting with others who have MdDS through online support groups and patient foundations is incredibly validating. It helps patients realize they are not alone and not imagining their symptoms, and allows for the sharing of coping strategies.

I’ve found that combining vestibular therapy with low-dose medications often helps patients regain control. Patience is key, this is a condition that improves slowly, but it does improve.

Mal de Débarquement Syndrome is a real and deeply disorienting neurological disorder that causes a persistent sensation of rocking and swaying. It is not a psychological illness, but a physiological condition of brain mal-adaptation. Its defining features, the onset after travel and the paradoxical improvement of symptoms when back in motion, make it a unique clinical entity. The diagnostic journey is often long and frustrating, marked by normal test results that can make patients feel disbelieved. While there is no simple cure, hope lies in ongoing research and a multifaceted management approach. What I always tell patients is this: your body may have stopped moving, but your brain hasn’t realized it yet. With the right tools and support, most people find relief, even if it doesn’t happen overnight.

National Organization for Rare Disorders (NORD). (2023). Mal de Debarquement Syndrome. Retrieved from https://rarediseases.org/rare-diseases/mal-de-debarquement/

National Institutes of Health, Genetic and Rare Diseases Information Center (GARD). (2021). Mal de debarquement. Retrieved from https://rarediseases.info.nih.gov/diseases/9534/mal-de-debarquement

Vestibular Disorders Association (VeDA). (n.d.). Mal de Débarquement Syndrome (MdDS). Retrieved from https://vestibular.org/article/diagnosis-treatment/types-of-vestibular-disorders/mal-de-debarquement-syndrome/