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A box of tissues and drop of blood | Can stress cause nosebleeds?
Wellness

Can stress cause nosebleeds?

When your blood pressure and cortisol levels increase, it raises your risk of this health condition
Heidi Borst
By | Aug. 27, 2024 Medically reviewed by Leslie Greenberg, MD

Key takeaways

  • Stress can contribute to nosebleeds by raising blood pressure and cortisol levels, which can lead to inflammation and affect blood vessel integrity.

  • Treat stress nosebleeds by sitting upright, applying pressure by squeezing the nose against the nasal septum for 10 minutes, and following specific steps to manage bleeding.

  • Preventive measures include staying hydrated, using humidifiers, applying Vaseline to the inside of each nasal passage at bedtime, and practicing stress management techniques.

  • Seek medical advice if you experience frequent or severe nosebleeds, especially if accompanied by additional symptoms.

In this article:

Picture this: You’re hiking in the Rocky Mountains, enjoying the sight of lush forests, alpine meadows, and sparkling lakes. Enraptured by the view, you don’t notice the blood trickling down your nose until it splatters on your shirt. You’re not surprised, though—dry conditions and high altitude create the perfect environment for a bloody nose. You pinch your nose to stop the bleeding and continue on your way.

But sometimes, nosebleeds can come on seemingly out of nowhere. They can even be related to stress. Keep reading to find out exactly how stressful situations contribute to nosebleeds, plus expert-backed strategies to stop and prevent them.

Can stress cause nosebleeds?

Stress can contribute to nosebleeds, says Rizwan Bashir, MD, a board-certified neurologist at AICA Orthopedics. He says the connection lies in how stress affects the entire body. “When experiencing stress, the body responds by increasing the production of hormones such as adrenaline and cortisol,” says Dr. Bashir. These hormones cause various physiological changes, including increased blood pressure. Elevated blood pressure can strain the delicate blood vessels in your nose, making them more susceptible to ruptures and, consequently, nosebleeds, he explains.

This increased fragility can heighten even more when combined with other factors like dry nasal membranes or habitual nose picking, says Robert Glatter, MD, a board-certified emergency medicine physician and assistant professor of emergency medicine at Northwell Health in New York.

About 60% of people will get a nosebleed at least once, with 10% requiring medical intervention. Nosebleeds (epistaxis) happen when tiny blood vessels in the mucosa that line your nostrils break or get injured, causing bleeding from one or both nostrils. While occasional nosebleeds can happen, you should discuss frequent occurrences with a healthcare professional.

There are two types of nosebleeds:

  • Anterior nosebleeds occur when blood vessels in the front part of the nasal cavity rupture, leading to bleeding. Nosebleeds in the front of your nose are common and usually resolve without seeing a medical professional. The most common causes of nosebleeds include environmental conditions such as dry air and low humidity, allergies, nasal trauma, or frequent nose-picking.
  • Posterior nosebleeds originate in the deeper blood vessels at the back of the nasal cavity. They are less common than anterior nosebleeds but can be more severe, resulting in significant blood loss requiring medical intervention. Posterior nosebleeds are often caused by underlying health conditions like high blood pressure, bleeding disorders (or taking anticoagulant medications) that interfere with blood clotting, or nasal injuries.

Scientific research has established a connection between stress and various physiological symptoms, including nosebleeds. For example, a large 2017 study found that individuals with medical conditions like obesity, hypertension, and chronic sinusitis and mental health conditions such as anxiety experienced a higher frequency of nosebleeds than control subjects.

Research indicates that high blood pressure is associated with more visits to the emergency room for nosebleeds, some of which are in the posterior location. Dr. Glatter points out that posterior nosebleeds require aggressive treatment and intervention beyond simple nasal packing and pressure to stop the bleeding. In other words, stress and anxiety disorders can elevate blood pressure, enhancing the risk of bleeding requiring medical attention.

RELATED: 6 surprising ways stress can affect your body

Stress nosebleed treatment

If you find yourself facing a nosebleed triggered by stress, Dr. Bashir offers a step-by-step guide to manage it effectively:

  1. Stay calm: Stress often worsens the situation. Take deep breaths to help relax.
  2. Sit upright: Lean forward slightly to prevent blood from running down the throat.
  3. Pinch your nostrils: Use your thumb and index finger to pinch your nostrils shut just below the bony part of your nose, and hold for 10-15 minutes to allow clotting. The Cleveland Clinic suggests spraying an over-the-counter decongestant nasal spray, such as Afrin (oxymetazoline), into the bleeding nostril before applying pressure to your nose. Only do this if you have Afrin on hand. Do not delay pinching the nose. 
  4. Apply a cold compress: Place an ice pack or cold cloth on the bridge of the nose. This helps constrict blood vessels and reduce bleeding.
  5. Avoid heavy exertion: Rest. Avoid activities that raise your blood pressure again.
  6. Avoid blowing your nose: Give your nose time to heal before resuming regular activities that may irritate it.

How to prevent stress nosebleeds

To prevent nosebleeds that may arise from stress, consider these practical tips:

  • Stay adequately hydrated: Drinking plenty of water to keep your nasal passages moist and less prone to bleeding.
  • Use a humidifier: Adding moisture to the air, especially in dry environments, can help prevent nasal dryness. Be sure to clean the humidifier regularly, per the instruction manual. 
  • Apply a thin layer of Vaseline: A small amount inside of your nose can maintain moisture and prevent irritation by keeping nasal mucosa lubricated.
  • Manage your stress levels: To mitigate stress, incorporate relaxation practices such as meditation, yoga, or deep-breathing exercises into your daily routine.
  • Limit the use of medications that increase bleeding: NSAIDs like aspirin and ibuprofen and the blood thinner Jantoven (warfarin) can increase the risk of bleeding. Medication adjustments should be made under the supervision of a healthcare professional.

RELATED: Stress statistics 2024

When to see a healthcare provider

While occasional nosebleeds are often harmless, certain situations require medical evaluation. “If simple pressure for 10 minutes doesn’t stop a nosebleed, and bleeding continues, it’s important to seek treatment in an urgent care or emergency department,” says Dr Glatter.

Seek advice from a healthcare provider if:

  • You experience frequent nosebleeds, or they last longer than 20 minutes.
  • The bleeding is heavy or accompanied by feelings of weakness or dizziness.
  • You notice other symptoms, such as unexplained bruising or recurring headaches.

The bottom line

Stress can influence blood pressure and the structural integrity of blood vessels, potentially increasing the risk of nosebleeds. You can reduce their occurrence by being mindful of your body’s signals and actively managing stress levels. If you have concerns about the frequency or severity of your nosebleeds, consult a healthcare professional for further guidance.