Musing: A False Sense of Relief

My poor head throbs with yet another sinus headache. A relentless drumbeat pounding behind my forehead and eyes. The pressure builds to an unbearable level, making it difficult to focus on anything except the relentless pain.

I become vampiric in my desire to avoid light. Any noise louder than a mouse fart reverberates in my brain. I want to crawl into a dark, quiet room and sleep until this agonizing sinus headache goes away.

In a cosmic joke for the ages, my body craves natural light and fresh air. Nothing is as invigorating for me as a day on a hiking trail, sitting on a mountaintop with the dogs, or strolling along the neighborhood greenway. Staying indoors feels like being a teenager grounded while his friends are cruising about town.

But I have a complicated relationship with the great outdoors. I love Mother Nature. Fresh mountain air. Beautiful scenery. Blooming flowers. The brilliant colors of autumn leaves.

She, however, doesn’t love me back. She slings dust, pollen, and an assortment of other allergens at me whenever we meet. Even, yes, those falling leaves crunching underfoot this time of year stir up a poison to my sinuses.

I accept the fact that sinus headaches will happen. I’m fortunate to have good health otherwise, so I embrace my curse with as much good humor as I can muster. And the help of pharmaceuticals.

Most medicines treat my headache like a weird cousin at a family reunion—awkwardly ignoring it. Neither aspirin nor acetaminophen dampens the pain in the slightest. 

Years ago, though, I discovered my miracle drug. Pseudoephedrine, most commonly sold as Sudafed™. Within a half hour of ingestion, the pain scampers away like a squirrel with a dog in chase.

Sadly, pseudoephedrine is the star ingredient in methamphetamine, the highly addictive and illegal recreational drug. To curtail the production of meth, Congress mandated in 2005 that pharmacists secure products with pseudoephedrine. Legitimate consumers must produce identification and are limited in the quantity purchased each month. Pharmacists must maintain records of all transactions for two years.

Fortunately, such strong efforts have resulted in the eradication of meth as a recreational drug.

No. Wait. That’s incorrect. Apparently, the use of meth has only increased since the law went into effect. Go figure.

To meet the demand of their customers, illegal drug manufacturers dispatched addicts, homeless people, and—grimiest of all—college students with fake or stolen IDs to purchase pseudoephedrine. The process even earned a nickname—smurfing.

To buy my pain relief in those early regulated days, I stood in line, usually behind some ratty-haired guy wearing a tattered fraternity shirt with an ID claiming he was a 73-year-old grandmother named Earlene. When my turn came, I tried not to look like I was there for meth despite my sniffling, red eyes, and head clutching. I slid my driver’s license across the counter, watched them scribble down my information in their logs (directly under Earlene, age 73), and imagined an ASEA (Anti-Smurf Enforcement Agency) armed with a search warrant kicking down my door.

Thankfully, the pharma gods gifted us Sudafed PE™, the same product only with phenylephrine. We sinus sufferers could pluck the product right off the shelf without playing “meth or meds” with the pharmacist. And it worked just as well!

Or did it?

An advisory panel to the Food and Drug Administration (U.S.A.) recently concluded that the oral form of phenylephrine is ineffective in treating sinus congestion. This is not some shocking new discovery, but a slow reaction to old news. Researchers have long argued the drug is ineffective.

The FDA must now decide whether to order the removal of the drug from the market. CVS has already announced they are removing it from their shelves. My cure is disappearing in the name of science.

Why did it work for me? Perhaps it was just the placebo effect—the pain went away because I believed it would. I’ll concede that’s possible. After all, I make up stories that make people laugh, cry, or get angry—and get paid to do it. Not exactly shocking that a pharmaceutical fiction suckered me into believing in magic.

The more logical reason is that antihistamines remain effective against allergies, even if they aren’t effective against congestion. It’s the reason some advocates argue phenylephrine should remain available, just not labeled as a decongestant. Count me in that group.

If it really was just a placebo, though, my knowledge of the science meant a chance that it would no longer work. I couldn’t risk it. I needed to bite the bullet and go back to the original medicine. I resolved to stand in line at the pharmacist counter, withstand the judging looks as I offered my ID, and purchase the real medicine—pseudoephedrine. Then I’d pray the ASEA didn’t arrive in the middle of the night, but at least I would be headache free.

But I didn’t go in time. I went out to admire the plethora of colors on our neighborhood trees. The headache wormed its way into my brain. With squinting eyes and thudding ears, I stumbled to the medicine cabinet.

A box of Sudafed PE™ mocked me from its position on the shelf. The FDA’s declaration of “ineffective” danced in my cringing head, but I was desperate enough to wish upon a star. Or, at least, upon a pill. I broke open the blister pack. Swallowed the pills. Settled into a chair with my eyes closed.

Thirty minutes later, the pain was gone. Placebo or not, I could move about the house without grimacing.

I’ll stock up before it disappears from the shelves. Better than being suspected of first degree smurf.

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