It's the season of stuffy noses and achy heads, a time when many people dash to their local drugstores in search of relief. But Step No. 1, before taking any over-the-counter decongestant, is to evaluate the likely cause of your stuffiness, advises Richard Rosenfeld, professor and chairman of otolaryngology at Long Island College Hospital in Brooklyn, N.Y.
Your nose "doesn't just swell up [inside] for no reason," Rosenfeld says. "It's important to understand why your nose" is stuffy. Sinusitis, for instance, may require an antibiotic, which means getting a prescription. Allergies may respond to an antihistamine. And structural problems, like a deviated septum, may require surgery. For persistent congestion, it's usually best to see your doctor, he says.
Once you've determined the cause of your stuffiness, here are some options for unclogging your nose:
• Consider nasal washings. A 2007 study published in the Archives of Otolaryngology—Head & Neck Surgery found that saline irrigation was more effective than saline spray for a group of patients with chronic nasal and sinus symptoms. "But many people who have colds [also] find it soothing," Rosenfeld says. "The basic principle is you need to irrigate, not just moisturize." Several nasal rinse kits are available on store shelves, or you can create a homemade kit: Squeeze about 4 to 8 ounces of saltwater into your nose "until there is no more mucous or cloudy material coming out," Rosenfeld suggests.
• Seek out pseudoephedrine. Some people say the oral decongestant phenylephrine—which replaced pseudoephedrine in many over-the-counter products in 2006—doesn't do a good job of unclogging their noses at the current 10-milligram dose. Pramod Kelkar, a Minneapolis allergist in private practice, says that some of his patients contend that it's less effective than pseudoephedrine, no longer residing on store shelves because it can be used to make methamphetamines. "Some patients feel like [phenylephrine] doesn't work at all," he says. While the Food and Drug Administration hasn't sanctioned a higher dose out of concern that too much can raise blood pressure, there are other options if phenylephrine (now a main ingredient in Sudafed PE, Robitussin cough syrup, and Benadryl Allergy & Sinus) doesn't work for you. Drugs containing pseudoephedrine are still available in limited amounts behind some pharmacy counters to those who show ID; no more than 9 grams per month or 3.6 grams per day can be purchased.
• Try a nasal spray, but don't use an over-the-counter decongestant spray for longer than 3 days. Overuse can create a rebound effect of narrowing and constricting the blood vessels of your nose, according to the Mayo Clinic. Prescription nasal sprays are also an option, if your doctor thinks they'll ease your congestion. Steroid sprays, such as Flonase and Nasonex, work by reducing swelling in the nose.
• Ask your doctor for a prescription oral decongestant. If your congestion is due to more than a simple cold—perhaps you're experiencing a nasty bout of sinusitis—it's reasonable to ask for a prescription oral decongestant, particularly if phenylephrine doesn't work for you and you're having trouble finding over-the-counter pseudoephedrine. "If a patient's condition warrants it...I would be happy to prescribe it," says Kelkar.
• Inhale steam. Sitting in front of a cool mist humidifier or using personal steam inhalation devices may loosen up congestion, Rosenfeld says.
Additional reporting by Hanna Dubansky.
Updated on 11/24/2010: This is an updated version of a previously published story.