Epistaxis, commonly known as a nosebleed, occurs when blood vessels rupture. This event, while often alarming, is usually not serious and typically originates from the anterior part of the nasal septum, an area known as Kiesselbach’s plexus. A long-standing but dangerous piece of advice is to tilt the head back to stop the flow. This action, intended to prevent blood from dripping out, actually redirects the blood flow to a much more problematic location, which is why it is strongly discouraged by medical professionals.
Why Tilting Back Is Dangerous
Tilting the head backward causes the blood to drain down the nasopharynx and into the throat, resulting in swallowing the blood. Swallowed blood is an irritant to the stomach lining and can quickly lead to feelings of nausea. This stomach irritation frequently results in vomiting, which can be forceful and may dislodge any forming clots, causing the nosebleed to start again or worsen.
The forceful action of vomiting also increases blood pressure in the head and neck, counteracting the body’s natural attempt to stop the bleeding. Especially if the person is unconscious or has a compromised airway, the blood running down the back of the throat could be aspirated. Redirecting the blood inward also prevents an accurate assessment of how much blood is actually being lost, giving a false sense that the bleeding has stopped.
The Correct Method for Stopping a Nosebleed
The first step is to remain upright, sitting down while leaning the head and upper body slightly forward. This forward-leaning posture ensures that any blood continues to exit through the nostrils or the mouth, where it can be spit out, rather than draining down the throat.
Next, the soft, cartilaginous part of the nose, located just above the nostrils and below the hard, bony bridge, must be firmly pinched shut using the thumb and index finger. This direct pressure is applied to the site of the bleeding blood vessels, facilitating clot formation. It is important to breathe through the mouth and maintain continuous pressure for a minimum of 10 to 15 minutes. Applying a cold compress or a bag of ice to the bridge of the nose may also help by causing vasoconstriction, though the evidence for this is not as strong as for direct pressure.
Common Triggers of Nosebleeds
Dry air, often caused by heated indoor spaces or arid climates, is a primary trigger because it dries out the nasal membranes, making the underlying blood vessels more vulnerable to rupture. Mechanical trauma from vigorous nose blowing or digital manipulation is another highly common cause, particularly in children.
Certain medications can also increase the likelihood of epistaxis, especially blood thinners like aspirin or warfarin, which interfere with the blood’s ability to clot. Misuse of nasal sprays, such as pointing the nozzle toward the septum instead of away from it, can cause localized irritation. Less common factors include acute sinus infections, allergies that cause inflammation, or a deviated nasal septum.
When to Seek Emergency Care
While most nosebleeds can be managed effectively at home, certain signs indicate the need for immediate professional medical attention. Seek care if:
- Bleeding persists despite two attempts at 10 to 15 minutes of continuous pressure (20 minutes or longer total).
- There is excessive blood loss, or blood is pouring down the back of the throat.
- The nosebleed occurs following a significant head injury, fall, or blunt trauma to the face, which may signal a fracture or internal injury.
- The person feels faint, weak, or dizzy, or is experiencing difficulty breathing.
- Nosebleeds are recurring, even if easily stopped, to identify any chronic cause.