Post-Nasal Drip

What is Post-Nasal Drip?

Post-nasal drip is the sensation of mucus draining from the nose and sinuses down the back of the throat. It is a symptom, not a disease, and when it causes a long-lasting cough it is called upper airway cough syndrome, a name that replaced postnasal drip syndrome.^[1]

Common symptoms

The main symptoms are a feeling of mucus in the throat, frequent throat clearing and a cough. Post-nasal drip is a recognized symptom of allergic rhinitis, together with nasal congestion, a runny nose, sneezing and itching.^[2]

• Throat clearing, a tickle or a lump-like feeling in the throat
• A cough that lingers for weeks and may be worse at night
• A blocked or runny nose, or facial pressure from a sinus problem

Causes and risk factors

Post-nasal drip has several possible causes, including allergic rhinitis, non-allergic rhinitis and chronic sinusitis.^{[1, 3]} Non-allergic rhinitis can be set off by triggers such as cigarette smoke, hormones, medicines and food.^[3]

Not every cough that feels like post-nasal drip comes from the nose. Upper airway cough syndrome, asthma and acid reflux together account for about 90% of chronic cough.^[1]

How it is diagnosed and treated conventionally

A physician diagnoses upper airway cough syndrome from your history and by excluding other causes, since there is no specific test.^[1] The diagnosis is confirmed when treatment of the nose makes the symptoms go away.^[1]

Treatment depends on the cause. A combination of an antihistamine and a decongestant is a standard approach for upper airway cough syndrome, and steroid nasal sprays are first-line for allergic rhinitis.^{[1, 2]} For non-allergic rhinitis, steroid sprays have low to very low certainty evidence of benefit and probably raise the risk of nosebleeds.^[3]

Why Post-Nasal Drip calls for a whole-person approach

Post-nasal drip is one symptom with many possible sources, and the best care starts by finding which one applies to you. The factors below are common contributors.

Care that supports comfort, sleep and general health is a reasonable addition to treatment of the cause. These links are associations, and they do not show that treating one factor fixes another.

Allergy and the airway as one system

Allergic rhinitis is now understood as part of a wider allergic response, and it often goes along with asthma and eczema.^[2] Treating post-nasal drip can therefore mean looking at the whole airway, not only the nose.^[2]

Sinus inflammation

Upper airway cough syndrome can occur with or without rhinitis or chronic sinusitis.^[1] If sinus disease is present, it needs its own medical assessment.

Triggers in the environment and body

Non-allergic rhinitis may be related to irritants, hormones, medicines or foods, which is why a careful history of your triggers is useful.^[3] Cough that seems like drip may come from reflux or asthma instead.^[1]

Sleep, mood and quality of life

A long-lasting cough can impair quality of life, sleep and productivity, and it is associated with anxiety, depression and social isolation.^[4] Support for sleep and stress is a reasonable goal alongside treatment of the cause.

Acupuncture for Post-Nasal Drip

What the research shows

There are no clinical trials of acupuncture for post-nasal drip itself. The closest evidence is for allergic rhinitis, a common cause, and it should be read as evidence for that condition. A meta-analysis of 30 trials with 4,413 participants found that acupuncture improved nasal symptoms and quality of life in adults with allergic rhinitis compared with no treatment and with sham acupuncture, but sequential analysis did not confirm the results and bias was common.^[5]

Another meta-analysis of 30 trials found that needle acupuncture reduced symptom scores, quality-of-life impact and medication use compared with sham acupuncture, with little difference in adverse events.^[6] An earlier meta-analysis of 13 trials with 2,365 participants reached a similar conclusion.^[7] Acupuncture was not clearly different from the antihistamines cetirizine or loratadine.^[5]

We know of no good-quality research on acupuncture for non-allergic rhinitis or for chronic cough from post-nasal drip, so benefit there is unknown.

How acupuncture may work

The review authors who studied allergic rhinitis suggested that acupuncture may modulate the immune system, but this is a proposal and not a settled finding.^[7] How acupuncture might act on post-nasal drip specifically has not been studied.

What treatment involves

Treatment uses fine, sterile, single-use needles placed at points on the face, head, hands and legs, usually left in place for about 20 to 40 minutes. A course usually involves several visits with reassessment.

Serious problems from acupuncture are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as brief bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[8] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture).

Ayurvedic medicine for Post-Nasal Drip

The Ayurvedic view

In Ayurveda, mucus draining from the nose is associated with excess Kapha, the principle linked to moisture and heaviness, and with nasal conditions the tradition calls Pratishyaya. These are traditional categories for choosing treatment, not biomedical diagnoses.

Therapies that may be used

Care is chosen for the individual and traditionally combines:

• Diet and daily routine intended to reduce Kapha, such as warm, lightly spiced meals and avoiding cold, heavy foods
• Steam inhalation and warm-oil practices for the head and neck
• Nasya, the placing of herbal oils in the nose, and Jala Neti, rinsing the nose with salt water, a practice that likely originated in the Ayurvedic tradition^[9]
• Herbal preparations such as triphala, which has been proposed as a candidate for allergic rhinitis^[10]

Panchakarma procedures are not appropriate during pregnancy, acute illness or frailty. Nasal therapies should wait until a physician has looked for an infection or another cause.

What the research shows

There are no clinical trials of Ayurvedic treatment for post-nasal drip. The research that exists concerns related conditions and is weak. A review of 13 Ayurvedic studies in chronic sinusitis found reported improvement but significant risk of bias in every study.^[11] A review of Jala Neti noted that most studies support its use in sinus and allergic conditions but that randomized trials are needed, and a broader review of nasal irrigation found that most studies had methodological problems.^{[9, 12]}

A review of Triphala for allergic rhinitis said that no studies had yet tested it for the disease.^[10] A randomized trial of 241 people with perennial allergic rhinitis found that curcumin, the main compound in turmeric, improved nasal symptoms and airflow compared with placebo over two months, though the authors called it a pilot study.^[13]

Herbal medicine for Post-Nasal Drip

Herbs and formulas that have been studied

Research on herbs for post-nasal drip has focused on Chinese herbal formulas for upper airway cough syndrome and on plant extracts for allergic rhinitis and sinusitis.^{[14, 15]} Herbs used in these studies include butterbur (Petasites hybridus), curcumin and various formulas that a practitioner would select by pattern.^{[13, 15]}

What the research shows

The evidence is limited. A systematic review of 16 Chinese-language randomized trials with 1,355 participants found that Chinese herbs, alone or with Western medicine, gave a higher recovery rate and better relief of cough and post-nasal dripping than Western medicine alone in upper airway cough syndrome. Most trials had an unclear risk of bias, and the authors called for higher-quality trials.^[14]

For allergic rhinitis, a meta-analysis of 32 studies found that herbal medicine beat placebo for nasal symptoms and quality of life, but only within about 12 weeks of use.^[16] Another review of 29 trials of single plants found very low to low certainty evidence of benefit over placebo and concluded that clear benefit is still lacking.^[15] A review of herbal products for chronic sinusitis found only four small randomized trials.^[17]

Safety and herb-drug interactions

Herbs are active substances and can interact with medicines. Case reports describe serious bleeding or clotting events when warfarin was combined with herbs including dan shen, dang gui, ginger, ginseng and Boswellia.^[18] Single medicinal plants appeared well tolerated up to 8 weeks of use in the allergic rhinitis review, but product quality and duration of use matter.^[15]

In one study, about one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[19] Herbs should come from tested sources and be prescribed individually. Tell us if you are pregnant or breastfeeding, have liver or kidney disease, take blood thinners, or have surgery planned.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine describes nasal discharge and throat mucus in terms of dampness, phlegm and weakness of the lung or spleen. Researchers studying herbs in allergic rhinitis look at things that loosely parallel this picture, such as anti-inflammatory, anti-allergic and anti-histamine effects.^[16]

Ayurveda's excess Kapha describes heaviness and mucus. No study has shown that a dosha or a qi pattern corresponds to a specific biological process in post-nasal drip.

How this care fits with your medical care

Integrative care for post-nasal drip is complementary. Keep your primary care physician, allergist or ENT specialist, and do not stop or change prescribed sprays, antihistamines or other medicines without your prescriber. We do not diagnose the cause of post-nasal drip or chronic cough, so a cough that lasts more than 8 weeks needs medical evaluation.^[4]

Please bring your diagnosis, any allergy test or imaging reports, a full list of medicines and supplements, and notes on what triggers your symptoms.

When to seek urgent medical care

A cough or throat symptom is not always from post-nasal drip, and some features need prompt assessment.^[4]

• Coughing up blood
• Shortness of breath, wheezing or low oxygen
• Fever, night sweats or unexplained weight loss with a cough
• Swelling of the lips, tongue or throat, or trouble swallowing
• Facial swelling or pain around the eye with a sinus problem

If any of these occur, call 911 or go to the nearest emergency department.