As a pharmacist by training (non-practicing), I can only share my protocol. As I get older I have begun to get these extremely painful experiences more frequently.
I take 60 mg of pseudoephedrine about 60-90 minutes before descent, then a couple of squirts of generic Arfrin in each nostril about 1/2 hour before descent. The pseudoephedrine works centrally to constrict the vessels and the Afrin topically. Since I started this, I have not had a problem.