What is the recommended treatment for a head cold?

Treatment for Head Cold

For symptomatic relief of the common cold in adults, use combination antihistamine-analgesic-decongestant products as first-line therapy, or alternatively use single-agent therapy with NSAIDs for pain/fever and short-term decongestants for nasal congestion, adding zinc lozenges (≥75 mg/day) if started within 24 hours of symptom onset. 1

First-Line Pharmacologic Treatment

Combination Therapy

• Combination antihistamine-analgesic-decongestant products provide significant symptom relief in adults and older children, with approximately 1 in 4 patients experiencing meaningful improvement. 1
• These combinations are particularly effective when multiple symptoms are present (nasal congestion, rhinorrhea, headache, malaise). 2, 1

Single-Agent Options for Targeted Symptoms

For nasal congestion:

• Oral or topical nasal decongestants reduce nasal blockage but should only be used short-term (3-5 days maximum) to avoid rebound congestion. 2, 1, 3
• Pseudoephedrine (oral) or oxymetazoline (nasal spray) are effective options. 3

For pain, fever, and malaise:

• NSAIDs (ibuprofen 400 mg or naproxen) are effective for headache, ear pain, muscle/joint pain, malaise, and also improve sneezing symptoms. 2, 1
• Acetaminophen (1000 mg) may help relieve nasal obstruction and rhinorrhea, though it does not improve other cold symptoms as effectively as NSAIDs. 2, 1

For rhinorrhea (runny nose):

• Ipratropium bromide nasal spray effectively reduces rhinorrhea, though it has no effect on nasal congestion and may cause minor nasal dryness. 1, 3

Evidence-Based Adjunctive Treatments

Zinc lozenges:

• Zinc acetate or gluconate lozenges at ≥75 mg/day, started within 24 hours of symptom onset, significantly reduce cold duration. 2, 1
• This must be taken throughout the entire cold duration to be effective. 2
• Potential side effects include bad taste and nausea. 1

Nasal saline irrigation:

• Provides modest benefit for symptom relief, particularly in children, and is safe with no drug interactions. 2, 1, 3

Vitamin C:

• May be worthwhile to try on an individual basis given its consistent effect on cold duration and severity, low cost, and safety profile. 2, 1

Treatments to AVOID

Antibiotics:

• Antibiotics have no benefit for the common cold, are associated with significant adverse effects, and contribute to antimicrobial resistance. 1, 4
• The common cold is viral; antibiotics are completely ineffective. 2, 3

Intranasal corticosteroids:

• No evidence supports their use for common cold symptom relief. 2, 1, 3

Antihistamines alone:

• Newer antihistamines (loratadine, cetirizine, fexofenadine) are ineffective for common cold symptoms. 3
• First-generation antihistamines have limited benefit when used alone, though they are effective in combination products. 1

Echinacea:

• Most Echinacea products are not effective, with only questionable weak benefit from some preparations. 2, 1

Steam/heated humidified air:

• Current evidence shows no benefits or harms. 2, 1

Treatment Algorithm

For mild, single-symptom presentation:

• Start with targeted single-agent therapy based on the predominant symptom (decongestant for congestion, NSAID for pain/fever, ipratropium for rhinorrhea). 1

For multiple symptoms:

• Use combination antihistamine-analgesic-decongestant products for broader symptom coverage. 1

Regardless of approach:

• Add zinc lozenges (≥75 mg/day) if the patient presents within 24 hours of symptom onset. 2, 1
• Consider nasal saline irrigation for additional relief. 1

Critical Pitfalls to Avoid

Inappropriate antibiotic prescribing:

• Antibiotics have no role in common cold treatment and contribute to antimicrobial resistance. 1, 4

Prolonged decongestant use:

• Limit topical nasal decongestants to 3-5 days maximum to prevent rebound congestion (rhinitis medicamentosa). 1, 3

Unrealistic patient expectations:

• Cold symptoms typically last 10-14 days in children and up to 2 weeks in adults; no treatment is curative. 1, 5
• Setting appropriate expectations prevents unnecessary follow-up visits and inappropriate antibiotic requests. 5

Missing the zinc window:

• Zinc supplementation is only effective if started within 24 hours of symptom onset. 2, 1