For anyone with migraine, the list of symptoms that commonly occur during a migraine attack is likely to be familiar — including headache, increased sensitivity to light and sound, nausea, and vomiting. So when a symptom occurs that isn’t on this list — especially if it happens during migraine attacks on a regular basis — it can be a source of confusion and concern.
Nosebleeds are a common symptom in general, but are not commonly associated with a migraine attack. Yet some people with migraine report having nosebleeds during migraine attacks, sometimes regularly enough that the connection is undeniable. So what’s going on when a nosebleed happens during a migraine attack?
“Nosebleeds are not a usual feature of migraine, and we do not typically see this combination of symptoms,” says Leon S. Moskatel, MD, a clinical assistant professor in the division of headache and facial pain at the Stanford University School of Medicine in California. Possibly because the combination is rare, “This hasn’t been explored too much in research,” Dr. Moskatel notes.
Here’s what we do know about the potential link between migraine and nosebleeds, as well as other potential causes of nosebleeds that could be responsible for them occurring during migraine attacks.
What Causes Nosebleeds?
Nosebleeds (also known as epistaxis) occur when the delicate tissue lining the inside of your nose — known as nasal mucosa — is injured and bleeds. Sometimes this injury can be even a minor scratch, so there isn’t always a known cause of the injury, such as your nose getting hit. Most nosebleeds happen near the front of your nose, known as an anterior nosebleed.
In rare cases, a nosebleed can happen deeper or higher up in your nose, known as a posterior nosebleed. This type of nosebleed can involve an artery and lead to much more bleeding, which typically drains down the back of your throat but can also come out of both nostrils. This type of severe nosebleed typically only affects people with an underlying health problem like high blood pressure or a bleeding disorder, or who take a blood-thinning (anticoagulant) medication.
A number of factors make a nosebleed more likely to occur, according to Harvard Medical School:
- Hot, dry indoor air (usually due to heating systems in winter)
- Deviated septum (wall between the nostrils is shifted to one side)
- Nasal allergies
- Common cold
- Cigarette smoke exposure
- Exposure to chemical irritants
- Heavy alcohol consumption
- Taking certain medications (including blood thinners and nonsteroidal anti-inflammatory drugs, or NSAIDs, such as aspirin or ibuprofen)
- Taking certain dietary supplements (including dong quai, feverfew, garlic, ginger, ginkgo biloba, ginseng and vitamin E)
It’s worth noting, Moskatel says, that “While low humidity can sometimes lead to nosebleeds, high humidity has been potentially linked to more migraine attacks.”
A Link Between Migraine and Nosebleeds?
One potential underlying factor that could be present in both migraine attacks and nosebleeds is an increase in blood pressure. But this doesn’t mean that people with chronically high blood pressure are more likely to experience migraine attacks or nosebleeds — in fact, the American Heart Association states that “In most cases, high blood pressure does not cause headaches or nosebleeds.”
Instead, an increase in blood pressure within areas of your head may be a temporary occurrence during migraine attacks, potentially contributing to a nosebleed. “Vomiting can also occur in patients with migraine, and the increased pressure from this can sometimes pop open susceptible blood vessels such as those in the nose,” Moskatel adds.
Overall, though, there is scant evidence that migraine and nosebleeds are linked. In fact, only a scattering of cases in which nosebleeds are linked to migraine attacks have been reported in published articles over several decades, according to Moskatel.
Since nosebleeds and migraine attacks are both fairly common health conditions, it’s possible that some of the overlap between the two is simply coincidental. “Nosebleeds are very common, with up to 60 percent of the population having at least one nosebleed over their lifetime,” Moskatel explains. “As a result, this connection between migraine and nosebleeds could be due to two high-probability events happening at or near the same time.”
In one of the few published articles in recent years examining nosebleeds during migraine attacks, researchers found just seven cases in which this symptom was documented during a person’s migraine attack. The age of the people in these reports ranged from 18 to 49, and five of them were women. Five of the seven people reported that the intensity of their headache was reduced when a nosebleed occurred, and all of them responded to medication to help prevent migraine attacks.
Finding the Cause of Your Nosebleeds
If you suspect that your nosebleeds are linked to migraine attacks, one way to help confirm or deny this link is to do everything you can to help reduce the frequency of your attacks. “We recommend that patients with migraine talk to their doctors about an optimal treatment plan including lifestyle changes, preventive medications, and acute treatments,” Moskatel notes.
If your nosebleeds become less frequent as you have fewer migraine attacks, then the two might be connected. If, on the other hand, you still have frequent nosebleeds when your migraine attacks become less common, then other causes may be to blame for your nosebleeds.
The good news is that nosebleeds are rarely a serious medical problem, and most can be stopped within a few minutes by pinching the upper part of your nostrils together for about 5 to 10 minutes. If you’re unable to stop a nosebleed after a couple rounds of pinching, or if large amounts of blood are running through the back of your throat or coming out both nostrils, seek immediate medical care.
Even if you have frequent nosebleeds that aren’t particularly severe, talk to your doctor about what could be causing them. It’s possible that certain lifestyle or environmental changes, like using a humidifier or limiting your exposure to certain chemicals, could help make your nosebleeds less frequent. And in some cases, your doctor may adjust or reevaluate a medication that is potentially linked to your nosebleeds.
Regardless of whether your nosebleeds are linked to migraine, here are some steps that can help make them less likely, according to the Cleveland Clinic:
- Use a saline nasal spray regularly.
- Humidify your bedroom at night, or your entire dwelling.
- Avoid blowing your nose forcefully.
- Don’t pick your nose or insert anything into it.
- Limit use of NSAIDs like aspirin or ibuprofen.
- Don’t overuse over-the-counter nasal allergy treatments.
- Don’t smoke.
- Wear protective headgear for activities that could cause injury to your nose.