What treatment is recommended for nasal congestion, headache, body ache, and nausea without fever, cough, sore throat, or ear pain?

Treatment for Viral Upper Respiratory Infection (Common Cold)

This presentation is consistent with an acute viral upper respiratory infection (common cold), and you should treat symptomatically with combination antihistamine-decongestant-analgesic therapy plus NSAIDs for body aches and headache—antibiotics and corticosteroids are not indicated and should not be used. 1, 2

Clinical Assessment

Your symptom pattern strongly suggests a viral URI rather than bacterial sinusitis because:

• No fever present (bacterial sinusitis typically presents with fever >39°C) 1
• Symptoms have not persisted beyond 10-14 days (the threshold for considering bacterial complications) 1
• No "double sickening" pattern (initial improvement followed by worsening, which suggests bacterial superinfection) 1
• Absence of severe purulent discharge with facial pain for >3 consecutive days 1

The European Position Paper on Rhinosinusitis provides level 1a evidence that antibiotics cause significant adverse effects without benefit for viral rhinitis and are not recommended. 1

Recommended Treatment Approach

For Nasal Congestion

Use oral or topical nasal decongestants for symptomatic relief:

• Oral pseudoephedrine (30-60 mg every 4-6 hours) provides small but positive effects on nasal congestion 1, 3, 4
• Topical oxymetazoline (2 sprays per nostril twice daily) can be used safely for up to 7-10 days without risk of rebound congestion 5, 4
• Multiple doses of decongestants show greater benefit than single doses, with effects measurable approximately 3 hours after dosing 4

For Headache and Body Aches

NSAIDs are the treatment of choice for these symptoms:

• Ibuprofen 400-800 mg every 6-8 hours provides significant benefits for headache, muscle pain, and malaise 1
• NSAIDs produce significant analgesic effects for headache, ear pain, and muscle/joint pain associated with viral URIs 1
• Acetaminophen (paracetamol) 650-1000 mg every 4-6 hours may help nasal obstruction and rhinorrhea but is less effective for body aches 1

For Nausea

The nausea is likely related to postnasal drainage and mucus:

• Consider metoclopramide 10 mg if nausea is significant, as it improves gastric motility and treats nausea effectively 1
• Ensure adequate hydration 2

Combination Therapy (Most Effective Approach)

Antihistamine-decongestant-analgesic combinations provide the best overall symptom relief:

• These combinations show general benefit in adults with common cold (level 1a evidence) 1
• First-generation antihistamine (like brompheniramine) with sustained-release pseudoephedrine addresses both congestion and rhinorrhea 2
• This approach treats multiple symptoms simultaneously and improves patient outcomes 1

What NOT to Use

Intranasal Corticosteroids

Do not prescribe nasal corticosteroids for the common cold:

• Level 1a evidence shows intranasal corticosteroids do not provide symptomatic relief for viral rhinitis 1, 2
• They are only indicated for allergic rhinitis or post-viral rhinosinusitis lasting >10 days 1, 6, 7

Systemic Corticosteroids

Absolutely avoid systemic corticosteroids:

• No benefit for cold symptoms and increase infection risk 2
• The Praxis Medical Insights summary explicitly states that deflazacort and other systemic corticosteroids provide no benefit and increase infection risk 2

Antibiotics

Do not prescribe antibiotics:

• Level 1a evidence demonstrates no benefit from antibiotics for the common cold 1
• Antibiotics cause significant adverse effects without improving outcomes 1
• Reserve antibiotics only for confirmed bacterial complications (symptoms >10 days, severe symptoms with high fever, or double sickening pattern) 1, 2

Additional Supportive Measures

• Nasal saline irrigation may provide symptom relief (level 1b evidence) 1
• Adequate rest and hydration support recovery 2
• Zinc lozenges ≥75 mg/day only if started within 24 hours of symptom onset 2

Expected Course and Red Flags

Typical viral URI resolves within 7-10 days: 1

Return for re-evaluation if:

• Symptoms persist beyond 10-14 days without improvement 1
• Development of high fever (>39°C) with severe facial pain for >3 consecutive days 1
• Initial improvement followed by worsening (double sickening) 1, 2
• Development of purulent discharge with unilateral facial pain 1

These red flags suggest possible bacterial sinusitis requiring antibiotic consideration. 1, 2