Nosebleeds: Head Forward, Not Back

Sit up, lean forward, and pinch the soft part of the nose continuously for five minutes. Do not tilt the head back. If the nosebleed followed a fall or a car crash, get medical attention now — that is a different situation entirely.

Most people were taught to tilt the head back, and that is the wrong instruction.

The American College of Emergency Physicians:

“Sit with head forward while pinching the nostrils together continuously for at least 5 minutes, or if bleeding persists, for 10 minutes.”

“Do not tilt head back (so as to avoid swallowing blood, which may cause nausea, vomiting and diarrhea).”

Head back does not stop the bleeding. It just redirects it down your throat — and swallowed blood makes people sick, which turns a manageable nosebleed into vomiting on top of it.

The one that is not really a nosebleed

Before the technique, the exception, because it is the thing worth knowing and almost nobody does:

“If a nosebleed occurs after a fall or car crash, seek immediate medical attention; this could be a sign of internal bleeding.”

A nosebleed after a head impact is not a bleeding nose. It is a finding. Do not sit at home pinching it for fifteen minutes. Go, and say what happened first and what your nose is doing second.

ACEP adds that where there has been a blow to the face, head or nose, evaluation is needed to determine whether there is a broken nose or a facial or head fracture. See head injuries and when to go.

The technique, and the word that matters is “continuously”

Sit up. Not lying down.

Lean forward, so blood drains out of the nose rather than back into the throat.

Pinch the soft part — the fleshy part below the bridge, not the bony bit higher up. Pressure on bone achieves nothing.

And hold it for five minutes without letting go. ACEP’s word is continuously, and it is the whole of why this fails for most people: they release at ninety seconds to see whether it has worked, which restarts the clot. If it is still bleeding, pinch for ten minutes.

Watch a clock. Five minutes with a bleeding nose feels like fifteen.

If the nose was struck, a cold compress or ice pack across the bridge “may help alleviate some swelling and discomfort” — that is comfort rather than a way to stop bleeding.

Come in

After 15 minutes. ACEP’s threshold: if bleeding persists beyond fifteen minutes, get medical assistance.

Straight away — do not wait out the clock:

• After a fall, a crash, or any blow to the head or face
• If you cannot control it with pressure at all
• If blood is running down the back of the throat while you are leaning forward — that can mean the bleeding is further back than pressure can reach
• If you feel faint, dizzy, short of breath, or your heart is racing
• If there is a lot of blood, or it keeps restarting through the day
• If you take a blood thinner or daily aspirin and it will not settle
• In a small child, if it will not stop or they have lost a noticeable amount

Our emergency rooms are open every hour of every day and are walk-in. Go to the nearest one, and if another emergency department is closer, that one is the right answer tonight.

If you are unsure, come in — this list is not exhaustive and you are not expected to judge how much blood is too much.

Two groups where the reasons differ

Older adults. ACEP notes that nosebleeds in older people may be linked to hardening of the arteries, high blood pressure, blood-clotting disorders, or medicines that interfere with clotting — aspirin among them. So a nosebleed at 75 is a slightly different event from a nosebleed at 15, and one that will not settle deserves a lower threshold.

Children. ACEP is reassuring, and it is worth repeating with its context: a spontaneous nosebleed in a child “can be alarming, but most nosebleeds are not serious.”

That reassurance is for the ordinary case only. It does not apply after a fall, a knock, or a bang to the head — which is also, in children, how a great many nosebleeds start. Ask what happened before you relax.

Questions people actually ask

Should I put my head back to stop it? No. That is the most common mistake here, and ACEP says so plainly.

Should I plug it with tissue? Pressure from your fingers is what ACEP describes. Packing a nose with tissue tends to come loose, gets stuck, and restarts the bleeding when it is pulled out.

It stopped and then started again an hour later. Common, and worth being seen for if it keeps happening through the day or will not settle with a proper five minutes of pressure.

I am on a blood thinner. Use the same technique, and have a lower threshold for coming in. Medicines that interfere with clotting are on ACEP’s own list of reasons these happen and keep happening.

My child gets them all the time in winter. Recurrent nosebleeds in a child are worth mentioning at a clinic appointment rather than an emergency room, unless one will not stop. Our clinics are open Monday to Thursday and Friday mornings.

How much blood is too much? Nobody can put a number on that from here. Feeling faint, dizzy or breathless is the answer — that is the body reporting the volume for you.

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Sit up, lean forward, pinch the soft part for five minutes without letting go — and never tilt the head back. After a fall or a crash, come in rather than waiting. Both of our emergency rooms are open 24 hours a day, every day of the year — walk in, no appointment and no referral. Find your nearest emergency room →

Related reading: head injuries and when to go · which door do you need

Sources

58. Nosebleeds — Know When To Go — American College of Emergency Physicians. https://www.emergencyphysicians.org/article/know-when-to-go/nosebleeds

This article is general information, not a diagnosis. It gives no doses. If you are unsure, come in — this list is not exhaustive and you are not expected to judge blood loss yourself. If it might be an emergency, treat it as one and call 911.