Possible Causes of Post-Nasal Drip

The main symptom of post-nasal drip is the feeling of having phlegm in the back of your throat. There are several different conditions that can result in the same symptom, and determining the cause is the best way to make sure you receive the best treatment.

Man suffering from post-nasal drip
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There are many causes of post-nasal drip, or phlegm in the throat. They include:

  • Allergic rhinitis (hayfever)
  • Non-allergic rhinitis (vasomotor rhinitis)
  • Sinusitis
  • Overuse of nasal sprays such as Afrin
  • Hormonal causes such as pregnancy or hypothyroidism

Despite the variety of causes, the symptoms are similar (e.g., frequent need to clear the throat).

Allergic Rhinitis

Post-nasal drip may be a symptom of allergic rhinitis (hayfever), although it’s quite uncommon to have post-nasal drip as the only symptom. Typically, allergic rhinitis symptoms also include sneezing, nasal congestion, and a runny/itchy nose.

People with post-nasal drip caused by allergic rhinitis are diagnosed in much the same way as those with other symptoms.

Positive results on allergy testing suggest that there is an allergic cause to the symptoms. Having a good response to treatment with medicines for allergic rhinitis also increases the chance that post-nasal drip is related to hayfever.

Non-Allergic Rhinitis

Post-nasal drip may also be caused by non-allergic rhinitis, or vasomotor rhinitis. A non-allergic cause may be suspected in an older person with post-nasal drip symptoms who did not have problems with allergies when they were younger.

Non-allergic triggers of post-nasal drip may include:

By definition, people with non-allergic rhinitis show no reactions to allergy testing.

Treatments for non-allergic post-nasal drip include nasal steroids, nasal antihistamines, anticholinergic nasal sprays (such as ipratropium bromide) and older oral antihistamines, such as Benadryl (diphenhydramine) or Chlor-Trimeton (chlorpheniramine), used for their drying side effects.

Sinusitis

Post-nasal drip may also be the only symptom of sinusitis (infectious rhinitis), or it may go along with other symptoms, such as facial pain, nasal congestion, and colored nasal discharge.

When post-nasal drip is the only symptom of a sinus infection, it is usually because the infection is a low-grade infection that has been going on for months—and sometimes even years. Because the symptoms of these types of sinus infections are so mild, a diagnosis is often only made after a computed tomography (CT) scan is performed.

Post-nasal drip caused by a sinus infection is treated with antibiotics, although the antibiotics may need to be taken for a longer-than-typical period of time if the infection is thought to be chronic (lasting for more than two months or keeps coming back).

Rhinitis Medicamentosa

Rhinitis medicamentosa is a complicated way to describe the type of a runny nose and congestion that occurs when a person has been overusing a medication like Afrin (oxymetazoline).

As the body adapts the medication, more and more of the medication is needed. Severe post-nasal drip may occur until the cycle is broken.

Hormonal Causes

Pregnancy-induced rhinitis, or hormonal rhinitis, is a common cause of post-nasal drip in those who are pregnant.

Symptoms usually begin during the second trimester and persist until delivery, resolving shortly after the baby is born.

For others, hormonal rhinitis may occur with the use of birth control pills or when thyroid function is low (hypothyroidism.)

Could It Be GERD?

While gastroesophageal reflux disease (GERD) does not cause post-nasal drip, it can cause the same sensation. If you have what seems to be post-nasal drip without a confirmed cause, see your healthcare provider. This is especially important if you have accompanying symptoms such as heartburn, chest discomfort, or abdominal pain. Not only does having reflux affect your quality of life, but it can have health complications.

A Word From Verywell

There are many causes of post-nasal drip. Some of them may be identified after reviewing your history, such as your symptoms, response to treatments tried, and when your postnasal drip occurs. An examination of the consistency of the drainage (thinner with allergic and non-allergic rhinitis, thicker with sinusitis) can also be revealing.

While you may have learned to live with your post-nasal drip, it is best to be evaluated by a healthcare provider so you can get a proper diagnosis and the most effective treatment. Post-nasal drip can impact your quality of life as well as your performance at work or school.

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Article Sources
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Additional Reading
  • Kasper DL, Fauci AS, Hauser SL. Harrison's Principles of Internal Medicine. New York: Mc Graw-Hill Education; 2015.

  • Kliegman RM, Stanton BF, St Geme III JW, Schor NF, Behrman RE, Nelson WE. Nelson Textbook of Pediatrics. 20th Edition. Philadelphia, PA: Elsevier; 2015.

  • MedlinePlus. Allergic rhinitis. Updated June 9, 2021.