Nasal Congestion - Causes, OTC, Prescription, and Herbal Remedies

The following refers to dry nasal passages with congestion/feelings of blockage or inflammation. On the other end of the spectrum, from a runny nose is sinus congestion. The blood vessels in the nose dilate and cause inflammation. It can be acute (transient) or chronic (ongoing). If severe, it can make a person miserable, and other areas of the body can be affected, like the ears, which directly connect with the sinus. Allergies, even high blood pressure, and barometric pressure changes can cause congestion. 

It is important to understand your sinus problem in order to treat it appropriately, so I am including the ,following discussion about nasal congestion - causes, OTC, prescription, and herbal remedies along with other methods of relief for congestion alone or congestion due to thick mucus.

Sinus Pain

Congestion can be chronic or ongoing, acute (short term), dry due to inflammation, or wet with thin or thick mucus. Thick mucus can cause an uncomfortable blockage and more inflammation. To treat congestion, it is important to try to determine the cause and nature of the problem. The following is a list of possible causes of acute and chronic congestion.

CAUSES OF ACUTE CONGESTION (sudden congestion)

When you have congestion alone with no mucus, it can be caused by several things:

​  -The BEGINNING of a cold or sinus infection

     -Allergies or exposure to irritants

     -Certain medications - aspirin, ibuprofen (Motrin, Advil), erectile dysfunction medications (for example, Viagra)

     -Pregnancy/menstruation

     -Alcohol consumption

     -Weather changes

     -Spicy foods

CAUSES OF CHRONIC CONGESTION (ongoing congestion)

Congestion for 12 weeks or longer is considered CHRONIC congestion. The following is a list of possible causes of congestion that you might consider:

 -Ongoing exposure to allergies in your environment (i.e., pets in the house).

     -Nonallergic rhinitis

     -Nasal polyps

     -Tumors (rare)

     -Deviated septum

     -Substance abuse (snorting)

     -Enlarged adenoids

     -Deviated septum

     -Dry air

     -Thyroid disorders

     -Hormonal changes

     -Certain medications:

          -beta-blockers (the ones that usually end in "olol")

          -sedatives

          -some antidepressants

          -oral contraceptives

-Some erectile dysfunction medications

-Some medications used for enlarged prostate

 -Very occasionally dry sinus infection (1)

          -ongoing use of certain nasal sprays like Afrin (oxymetazoline). Nasal steroids like

Flonase and Nasonex do not have this effect

If you suspect that a medication you are using may be causing this, let your primary care provider know. DO NOT STOP or change up your medications without consulting with your primary care provider!

IF YOU HAVE CHRONIC CONGESTION AND DO NOT KNOW THE CAUSE, YOU MAY WANT TO CHECK WITH AN ALLERGIST AND/OR ENT (ear, nose, and throat specialist). Of course, specialists are expensive, so it may be worth your while to try to figure out the problem and work on a resolution first. In the meantime, you have many choices to try on your own—see below.

TREATMENT OF NASAL CONGESTION

OVER-THE-COUNTER APPROACHES TO DRY SINUS CONGESTION

(DRY/INFLAMMATORY /LITTLE TO NO MUCUS)

The following are links to helpful approaches to different types of nasal congestion. The type of treatment depends on whether the congestion is due primarily to inflammation or due to the presence of mucus. 

This is a dry, stuffy feeling where you cannot breathe easily out of your nose. If you are unsure if that stuffiness is due to mucus or inflammation, try some nasal saline spray or guaifenesin (Mucinex Plain) as directed over the counter (with plenty of water). If your nose starts to drain, then it is not pure inflammatory congestion. You likely have mucus hiding in your sinus! 

But don't dry it up too much if you have thick mucus.

Sudafed or "D" Products (Decongestants- "D" is the same as pseudoephedrine (and "D" is NOT the same as "DM") - This is a very good nasal decongestant. Still, it has a lot of potential side effects: Sleeplessness, jitteriness, blood pressure elevation, heart racing or palpitations, and nervousness, among others. I have seen the blood pressure of people (with no history of blood pressure) skyrocket to near-stroke levels with this medication. Aside from side effects, there are also some potential drug interactions  (see side effects and interactions in GoodRx).  I do not recommend it much except for young, healthy people. Because of the drying effect of this medication on mucus, if you do take it, it is important to stay well hydrated so you do not collect dry mucus in the sinus and foster a sinus infection.

Phenylephrine is an oral decongestant found in many over-the-counter cold and flu products. The FDA recently claimed it was ineffective, and judging by what patients say, the FDA is probably right. Interestingly, phenylephrine products are still on many pharmacy shelves. Sudafed is a much better product, but it still has many potential side effects.

Afrin or Dristan, Mucinex MAX (oxymetazoline) nasal sprays are very helpful in decongesting and have a great reputation for helping ear symptoms related to congestion. The medication remains more localized so that, while you can get them, you will likely NOT get all of the side effects you might have with the oral decongestants. You can only use the oxymetazoline nasal sprays for two to three days; otherwise, you will likely develop rebound congestion (rhinitis medicamentosa) and must use them continuously to keep your nasal passages clear. Ongoing use is NOT recommended. Typically, 2-3 days is enough to get through your worst symptoms.

Sinus Buster Nasal Spray is a decongestant made with saline, capsicum (pepper), vitamin C, and rosemary. According to reviews, it works well for people, but the problem is tolerability: It stings the nose and burns the eyes. This is not suitable for allergy-related congestion. Because this nasal spray does not cause rebound congestion, you can use it for more than three days.

Nasal Saline Sprays, like Ocean Nasal Spray, are well-liked products. Saline can help with inflammation; it moisturizes mucous membranes, clears out foreign particles, and helps prevent sinuses from getting infected.

Nasal Steroids (examples: Flonase, Nasonex, Rhinocort, Beclomethasone, and budesonide, which is a generic): These are usually the best for chronic congestion like allergies, although sometimes we recommend them for sinusitis. They are costly and often do not take full effect for 2-3 days, so sometimes patients stop using them too early in treatment, feeling that they do not work. Nasal steroids do not cause the same rebound effect that Afrin does - that is, they do NOT cause congestion if used for an extended period.  Be sure to look down at your feet while spraying this in your nose: It will penetrate the sinus more effectively, and you will not lose as much of it down your throat. These work faster than oral antihistamines.

Antihistamines (Claritin, Allegra, Zyrtec) - These are also the best oral medications for chronic congestion related to allergies. They are more for sniffles and sneezing. Like Sudafed, they can dry your sinuses out and set the stage for a sinus infection.

Mast Cell Stabilizers (NasalCrom) nasal spray works by acting on cells and chemicals responsible for nasal and sinus inflammation.

NOTE: If you have chronic sinus congestion due to overuse of Afrin (over three days), think about weaning off it by slowly introducing Flonase, Nasonex, or Rhinocort. This takes about two weeks. (Ask your doctor for an oral steroid.) People tell me about their dads who have been using this stuff for years - they have Afrin bottles in their shirt pockets, on the mantlepiece at home, and in their car. Their nose runs more without it, and they cannot breathe through their nose without it because they have "rebound congestion" from using it for so long. There is often mucosal damage as well.

Xlear is a nasal saline with xylitol, which reportedly helps relieve congestion by decreasing inflammation. Xlear also has a "MAX" with aloe vera, grapefruit seed extract, and capsicum, which also acts as an anti-inflammatory. Because of potential irritation, it is only for episodic use—not for daily use. Some people report a burning sensation in the nose when using this spray.

NATURAL REMEDIES FOR SINUS CONGESTION

There are a variety of alternative remedies that you can try. If they work, consider keeping them on hand at home.

Tulsi or Holy Basil Tea. This is an Ayurvedic treatment that is reputed to help with congestion. It also has antiviral, antimicrobial, and antifungal properties. The National Institute of Health has conducted research that claims a number of benefits to this herbal supplement.

Sinupret (Tablets and liquid) - This oral herbal combination medication has been used in Europe for many years as a decongestant. Many studies have been done on it, and it is widely acclaimed for its efficacy. It is made up of elderflowers, primrose flowers with calyx, common sorrel, European vervain, and gentian root. Many of these components are acclaimed in the herbal medicine world.  Sinupret does not have many of the side effects that our over-the-counter decongestants have. This also comes in liquid form. 

Goldenseal (tablets and capsules) - This herb has many purported health effects. It is an antimicrobial and helps decrease the inflammation of the a nasal mucosa, thereby helping with congestion. It can also help contain a watery, runny nose. If you use this, you should stay hydrated and consider using nasal saline spray if the nose is too dry. 

OILS:

These may be used via aromatherapy and some taken as teas (follow instructions with product carefully): 

Peppermint is known to help with nasal and chest congestion. It is generally used as a tea, in a diffuser, or orally as a lozenge.

Lemon Balm is a natural anti-inflammatory and antihistamine (among other great properties).

(3). It can be added to a tea, applied as a poultice, steeped in hot water, or inhaled, to name just a few preparations.

Sinus Message - I have had an occasional patient who swears by massage for congestion (and the "release" of mucus. If other methods are not working, you can try this (see YouTube video instructions below). 

PRESCRIPTIVE TREATMENT OF NASAL CONGESTION...

(Prescribed by a Healthcare Provider)

When you cannot breathe through your nose, everything you have tried has failed, and you are miserable, you may want to see your healthcare provider. Several prescription medications may help.

In most cases of congestion due to allergy or cold symptoms, the over-the-counter medications are adequate. But if you are unable to relieve your congestion with one of those, if you have frequently recurring episodes of sinus problems or if you have severe sinus symptoms—like facial pain or swelling, a fever, it is important that you follow up with a healthcare provider.

Healthcare providers may decide to prescribe one of the following medications, which inhibit the inflammatory cell actions responsible for excessive inflammation.

Ipatropium bromide nasal spray (formerly "Atrovent" but now generic) is an anticholinergic spray that decreases sinus inflammation.

Singulair (montalukast) - oral. This is an interesting medication that periodically makes the news because a number of patients taking it have developed mood problems like "anxiety, aggressiveness, irritability, and restlessness" in addition to rare episodes of suicidality (1). It is still on the market, and for some people, it seems to work very well for chronic allergies and asthma. Is it worth the risk? You decide.

Oral Corticosteroids (like prednisone or dexamethasone) - In most cases, the over-the-counter medications are adequate. Still, suppose you really cannot breathe through your nose despite using the over-the-counter or alternative methods. In that case,  your healthcare provider may decide to prescribe low-dose, short-course oral steroids to decrease the inflammation. They tend to work quite well. (Oral steroids may be contraindicated in those with underlying medical problems like diabetes and high blood pressure.) 

Note: On rare occasions, specialists prescribe monoclonal antibodies for severe congestion that is not responsive (refractory) to medications and surgery.