Dr. Michael Lee graduated from Stanford University with honors and received his medical degree from the University of Chicago in 1996. Dr. Lee completed his internal medicine residency at Mount Auburn Hospital, a Harvard Medical School teaching hospital.

A Cold vs the Flu

This post was inspired by marmite’s question that went something like this,

“I’ve got the flu a stupid cold, should I take Nyquil?”

Many people use the term flu to mean a bad cold which is partly correct.

A Cold is a viral infection of your nasal passages which causes a runny nose. At night, mucus can run down your throat (post-nasal drip) and make you cough from a gagging reflex. In the morning, you’ll often have a sore & scratchy throat from the mucus which improves after taking a shower or gargling with salt water.

I’ve become a fan of a prescription nasal spray called Atrovent for a runny nose.

For nasal congestion (feeling blocked), I usually recommend Sudafed during the day since it can cause insomnia. Start with half the recommended doses to avoid over drying out your nose which is unpleasant. Make sure to get Sudafed and not Sudafed PE (which doesn’t work as well). You’ll know you’re getting the right medicine if you have to show your driver’s license (to prevent people from converting it into methamphetamine).

My mom’s favorite remedy is snorting salt water up your nose which actually has been studied and found to work well.

The Flu is also caused by a virus with the same symptoms as a cold (cough, sore throat, runny or stuffy nose), but you usually have a sudden attack of high fever, headaches, muscle aches, and extreme tiredness. You feel like you’ve been hit by a mack truck.

The big difference between a cold and the flu is that there is anti-viral medication (Tamiflu) for the flu. Tamiflu can reduce your symptoms by 3 days if you take it in the first 12 hrs or 1 day if you take it in the first 48 hrs. Some insurances don’t cover it. It costs around $93 if you’re paying cash so you’ll have to decide if it’s worth it to you.

In addition to bedrest, if you don’t have an ulcer and you haven’t had stomach problem with medicines like Advil, consider taking double doses of ibuprofen (Motrin, Advil) 4 pills 4x/day or naprosyn (Aleve) 2 pills 2x/day with food. At these dosages, you will get an anti-inflammatory effect in addition to pain and fever rellief which is better to control muscle pain. You can take Tylenol on an empty stomach and it’s good for pain and fever, but there is no anti-inflammatory effect.

Last thing, the cough in a flu is partly because the virus causes you to shed the lining of your large airways. One complication of the flu is that you’re a setup for bacterial pneumonia a few days after your attack of flu.

Flu Shots There’s plenty of flu shots for everyone these days. I advise it people who are exposed to sick people, have other medical problems like asthma, or who can’t afford to miss a day of work. It can make you a bit sick after you get it so I have people hold off if they’re going on a trip or have an important event coming up.

Cold Medicines usually have a combination of this and that which increases the risk of side effects like sedation. I usually recommend just taking the specific drugs you need to relieve your symptoms. I should also say that I think Robitussin without codeine (a narcotic) is not helpful.


  1. Stephen Chen Said,

    November 12, 2008 @ 11:32 am

    This is super useful. Thanks!

  2. drmikelee Said,

    November 13, 2008 @ 12:15 pm

    Great! I’m glad at least one person is getting something out of this blog = )

  3. Howge Said,

    March 9, 2009 @ 8:54 pm

    I found that the neti pot technique works really well! “Snorting” salt water refined I suppose . . .

  4. Kevin Clarke Said,

    April 18, 2009 @ 5:54 pm

    Thanks for the advice

  5. Peter Said,

    August 29, 2009 @ 11:01 pm

    I snorted salt and it hurt BUT it cleared everything up the next morning. it kind of felt rewarding and painful at the same time. My wife gave me the crazy look while I snorted.

  6. Phyllis Hunt Said,

    November 18, 2011 @ 7:51 am

    Mom always knows best! It works and it is best not to use “iodized” salt. Tends to sting a bit.

  7. female body Said,

    August 13, 2014 @ 10:08 pm

    This is a good tip especially to those fresh to the blogosphere.
    Simple but very precise information… Appreciate your sharing this one.
    A must read article!

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