Does Pseudoephedrine Work For Migraine?

Pseudo means false or untrue, as in “pseudointellectual,” a name for someone who is really not very smart.  The “ephed” part of the word is taken from the plant, Ephedra,  a naturally occurring alkaloid.  It may be spelled as “pseudofed” or “Sudafed.”

This is an article by Britt Talley Daniel MD, member of the American Academy of Neurology, the American Headache Society, migraine textbook author, podcaster, YouTube video producer, and blogger.

Pseudoephedrine is a mystery drug that confuses people, especially Migraineurs.  Does pseudoephedrine work for “sinus headache,” a deceiving term that usually denotes Migraine?  Does it Work For Migraine?

Read my Mini Book on Migraine Here.

The Migraine process causes cerebral arteries to vasodilate and pseudoephedrine causes vasoconstriction of these same arteries. It is a weakly effective drug for Migraine. Pseudoephedrine is also effective as a nasal/sinus decongestant, a stimulant, and as a wakefulness-promoting agent.

Pseudoephedrine is a sympathomimetic drug which imitates the effect of the sympathetic nervous system.  It is a drug in the amphetamine and phenethylamine chemical classes.

Related questions.

Who discovered pseudoephedrine?

It was first used in 1889, by the German chemists Ladenburg and Oelschlägel.  They used a sample that had been isolated from Ephedra vulgaris by the Merck pharmaceutical corporation of Darmstadt, Germany.

What chemical form of pseudoephedrine is commonly used in medicine?

The salts pseudoephedrine hydrochloride and pseudoephedrine sulfate are found in many over-the-counter preparations.  They are dosed either alone or packaged with other active drugs such as antihistamines, guaifenesin, dextromethorphan, paracetamol (acetaminophen) or an NSAID (such as aspirin or ibuprofen).

What are examples of pseudoephedrine drugs?

Pseudoephedrine HCL is a common drug in many over the counter sinus medications.  Typical examples are listed below.

US Brand Name

1. 12 Hour Cold Maximum Strength

2. Biofed

3. Cenafed

4. Chlor-Trimeton Nasal Decongestant

5. Contac 12-Hour

6. Dimetapp Decongestant

7. Efidac 24 Pseudoephedrine

8. ElixSure Congestion Childrens

9. Genaphed

10. Pediacare Decongestant Infants

11. Simply Stuffy

12. Sudafed

How does pseudoephedrine work?

Pseudoephedrine causes vasoconstriction of the small blood vessels in the nose and nasal sinues.  It acts as a decongestant.

The extremely vascular nasal mucosa shrinks in response to this vasoconstricting drug which opens the nasal passages.  The patient breathes again. The advantage of the drug is that it produces a gradual but sustained decongestant effect, causing little “rebound” congestion. Afrin, an acute acting over the counter drug for nasal stuffiness.

Ever heard of “Rebound Congestion & Rhinitis Medicamentosa?” No, well it is a terrible experience. I’ve had it myself a few times. It comes after a cold and overtaking Afrin. Please read my article on this on my website, doctormigraine.com so you learn about it and never get it. See the picture of that guy on the picture, that was me for sure. Click to read.

Although it exerts a sympathomimetic effect, it does it indirectly.  It is better for the nose to get a decongestant orally, through a pill, than by directly putting something in the nose, such as Afrin nasal spray, which typically causes decongestant rebound if used more than a few days.

Confused about vasodilatation/vasoconstriction? Please read my article, “What is a Vascular Headache?” on my website, doctormigraine.com. That will straighten you out.

Pseudoephedrine side effects.

Pseudoephedrine has rather common and unwanted side effects.  These are also usually listed on in small print.  With continued use and especially at high doses, tolerance to the medication develops and as the user increases the dosage, toxic signs and symptoms may occur.

Common adverse drug reactions associated with pseudoephedrine therapy include central nervous system stimulation, insomnia, nervousness, excitability, dizziness and anxiety. Infrequent drug reactions include tachycardia or palpitations.

Rarely, pseudoephedrine therapy may be associated with mydriasis (dilated pupils), hallucinations, arrhythmias, hypertension, seizures and ischemic colitis as well as severe skin reactions known as recurrent pseudo-scarlatina, systemic contact dermatitis, and nonpigmenting fixed drug eruption.

Pseudoephedrine, particularly when combined with other drugs including narcotics, may also play a role in the precipitation of episodes of paranoid psychosis. It has also been reported that pseudoephedrine, among other sympathomimetic agents, may be associated with the occurrence of stroke.

Pseudoephedrine precautions and contraindications

Pseudoephedrine is contraindicated in patients with diabetes mellitus, cardiovascular disease, severe or uncontrolled hypertension, severe coronary artery disease, prostatic hypertrophy, hyperthyroidism, closed angle glaucoma, or by pregnant women. The safety and effectiveness of nasal decongestant use in children is unclear.

Pseudoephedrine can aggravate other neurologic symptoms.

Another problem exists for anxious or panic attack patients who may become more agitated on pseudofed, which acts in a lot of ways like caffeine.  Patients with tremor, either Parkinson’s Disease or Essential Tremor, may find their shaking is worse if they take pseudofed.

Pseudoephedrine interactions

Concomitant or recent (previous fourteen days) monoamine oxidase inhibitor use can lead to hypertensive reactions, including hypertensive crises.

The antihypertensive effects of methyldopa, mecamylamine, reserpine and veratrum alkaloids may be reduced by sympathomimetics.  Beta-adrenergic antagonists may also interact with sympathomimetics.

Increase of ectopic pacemaker activity can occur when pseudoephedrine is used concomitantly with digitalis.  Antacids increase the rate of pseudoephedrine absorption, while kaolin decreases it.

Accidental dosing of pseudoephedrine

Pseudoephedrine is often appended to an antihistamine medication.  It is the D, or Decongestant in drugs like Claritin (loratadine-D).  The antihistamine causes the altered immune function relieving the allergy symptoms and the Decongestant, pseudoephedrine, causes nasal arterial constriction.

The side effects surprises some people who don’t realize what their doctor has ordered and they find that they can sleep fine on plain Claritin (loratadine), but they can’t when they get Claritin (loratadine)-D.

Does pseudoephedrine help “sinus headache.”

There is no “sinus headache,” an entity which is not listed in the International Classification of Headache Disorders (ICHD 3).  The phrase “sinus headache” refers to Migraine without Aura. The pseudofed industry has marketed the phrase “Sinus headache” since the 1950’s to sell their drug.

Patients with “sinus headache,” may find that their headache gets better after they take an over the counter medication which contains a pain killer and pseudoephedrine.  The true story is that their migraine headache, caused by vasodilatation of arteries in the brain and release of inflammatory neurochemicals , is mildly better following the vasoconstrictor effect of pseudoephedrine.

Allergic rhinitis. Everybody needs to know what this is because it’s misnamed “sinus,” “hayfever,” and “allergies.” Please read my article on “Allergic Rhinitis” on my website, doctormigraine.com and call it by the right name. Click here to read.

This is a very confusing and poorly understood subject for most people. Learn more about “Sinus, Allergy, or Migraine headache” by reading my article on my website, doctormigrainie.com. Click here to read.

However, pseudoephedrine treatment for a “sinus headache” Migraine is not as effective as using a triptan drug at onset which can give the patient a headache free time in 2 hours. Triptans block the release of the 3 inflammatory neurochemicals which activate migraine. Pseudoephedrine treatment for Migraine usually doesn’t make the patient headache free.

If you've got migraine, you need to know about triptans for acute therapy. Triptans changed the migraine world. Learn more about “Triptan therapy for migraine?” by clicking on the article in my website at doctormigraine.com..

The dark, stormy side of using pseudoephedrine.

Pseudofed has a stormy side also.  It has been on FDA newsletter alerts sent to physicians warning of its habituating qualities.  Drug addicts, operating home meth labs, often buy up large doses of pseudofed and then change it to methamphetamine, a structurally similar chemical.

The pseudofed industry has misled the American population since the 1950’s with TV ads on “Sinus Headache.”  The International Classification of Headache Disorders 3 doesn’t recognize “Sinus Headache” which is usually migraine.  Read my article on Sinus Headache at www.doctormigraine.com.

Pseudoephedrine is a common drug contributing to “Medication Overuse Headache” (MOH). If you don’t know about that, read my article on MOH on my website at doctormigraine.com. Click here to read.

Check out my Big Book on Migraine Here.

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All the best.

Britt Talley Daniel MD