Can Headaches Trigger Nosebleeds?

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Ignoring high blood pressure headaches which can potentially rupture blood vessels in the nose leading to a nosebleed, can headaches in and of itself trigger nosebleeds? I encounter a few patients a year who report that a particularly bad headache triggered their nosebleed, also known as epistaxis.

But can this actually be true?

After all, headaches are common and nosebleeds are common. As such, statistically, two common events could at times occur simultaneously by chance alone leading to erroneous association or causation.

That said, there are a handful of reports that suggest that migraine headaches could potentially trigger nosebleeds. See references below.

A common theme is that migraine triggered nosebleeds typically occurred between the peak severity of the headache and the beginning of its resolution. Therefore, it could be considered a symptom of the resolution phase of migraine during which migraine sufferers may also experience vomiting, sweating, lacrimation, etc. With respect to nosebleeds, the trigeminovascular system may be activated  causing significant vasodilation of blood vessels in the nose making them more prone to rupture and subsequent bleeding.

Of course, given the sparsity of medical reports on headache induced nosebleeds, it's hard to say whether there is a true association or not.

But it is something to keep in the back of the mind.

For individuals who have not yet been evaluated by a physician and especially a neurologist for recurrent migraine headaches, one can try some over-the-counter supplements that have been found helpful in reducing the frequency and severity. These supplements include butterbur 75mg 2x per day, magnesium oxide 400mg per day, vitamin B2 100mg 2x per day, and/or coenzyme Q10 100mg 2x per day.

References:
Migraine-Induced Epistaxis and Sporadic Hemiplegic Migraine: Unusual Features in the Same Patient. Case Rep Neurol. 2012 May-Aug; 4(2): 116–119.

[New concepts on the diencephalic origin of epistaxis and migraine. Clinical observations]. Rev Neurol (Paris). 1968 Aug;119(2):229.

Migraine and recurrent epistaxis in children. Pediatr Neurol. 2005 Aug;33(2):94-7.

Intractable epistaxis associated with topiramate administration. Ann Pharmacother. 2006 Jul-Aug;40(7-8):1462-5. Epub 2006 Jul 5.

Migraine-induced epistaxis. Headache. 1986 Nov;26(10):517-8.

Epistaxis accompanying migraine attacks. Cephalalgia. 2007 Aug;27(8):958-9.