Over-the-counter decongestants were more frequently associated with symptom relief among patients with nonrhinogenic facial pain compared with those with chronic rhinosinusitis, according to a cross-sectional survey of 251 adults presenting with chronic midfacial pain or pressure at a tertiary academic rhinology clinic.
Nearly half of patients with nonrhinogenic facial pain (NRFP) (49%) reported “sometimes” to “always” experiencing relief after using decongestants, compared with 31% of patients with chronic rhinosinusitis (CRS). No statistically significant differences were found between the groups for other common over-the-counter (OTC) medications, including intranasal corticosteroids, oral antihistamines, caffeine, or general pain relievers.
“This study is the first to assess OTC medications for sinus headache in patients with both CRS and NRFP,” said lead author Noah G. Sattah, MD, of the Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine.
Across the full cohort, 44% reported some relief from intranasal steroid sprays, 42% from pain relievers, 41% from decongestants, and 40% from oral antihistamines. Approximately one-fourth of participants indicated they had not tried these treatments. Among patients with CRS, the highest proportion of “sometimes to always” relief was reported for pain relievers (39%), followed by intranasal steroids (38%), oral antihistamines (36%), and decongestants (31%). In contrast, patients with NRFP reported higher rates of perceived relief from intranasal steroids (50%), decongestants (49%), and pain relievers (45%).
The study included 114 patients with CRS (45%) and 137 with NRFP (55%). The mean age was 50 years, and 69% were female. One-third (33%) had prior sinonasal surgery, and nasal congestion was the most common secondary complaint, (63%).
The survey, conducted between September 2022 and February 2024, included adults aged 18 years or older who experienced chronic midfacial pain or pressure for at least 3 months. Patients were classified as CRS or NRFP using guideline-based diagnostic criteria, which incorporated sinus computed tomography and nasal endoscopy.
Participants completed a questionnaire on their use of OTC, including decongestants, intranasal steroids, oral antihistamines, caffeine, and pain relievers. They rated how often each medication provided relief on a five-point scale ranging from “never” to “always.” Statistical analyses compared response patterns between CRS and NRFP groups using chi-square tests.
The researchers noted several limitations. Because the study was conducted at a single academic center, the results may not represent other populations. Self-reported data introduced potential recall bias. The survey did not distinguish between topical and oral decongestants, though most patients likely used oral formulations. The analysis also did not account for combination products or concurrent prescription medications, which may have influenced perceived relief.
Decongestants were more commonly associated with symptom relief in NRFP than in CRS, suggesting that patient-perceived effectiveness of OTC sinus medications may differ depending on the underlying cause of facial pain. The researchers emphasized that physicians should evaluate self-treatment habits when assessing patients with chronic facial pain to better differentiate sinus-related from non-sinus-related conditions.
The study was funded by the Association of Migraine Disorders. Two researchers served on the organization’s board.
Source: Oto Open
