Headaches and Nosebleeds in Children

Together, these symptoms may signify an underlying problem

Little girl lying in bed, not feeling well

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By themselves, both nosebleeds and headaches are common in children (at least children over the age of two) and are usually not caused by a serious problem. Together, however, these two symptoms might indicate a potentially serious issue. While an upper respiratory infection, sinus condition, or even a foreign body in the nose is more common, serious conditions ranging from head trauma to tumors may need to be considered. Surprisingly, nosebleeds may even be a part of childhood migraines.

Symptoms

Both nosebleeds (epistaxis) and headaches can be caused by a wide variety of issues in children.

Nosebleeds (Epistaxis)

Nosebleeds (epistaxis) are common in mid-childhood, with the incidence highest in children between the ages of three and eight. Roughly 56% of children between the ages of six and 10 will have at least one nosebleed each year.

Nosebleeds are uncommon before the age of two. A nosebleed in a very young child should always be checked out.

Nosebleeds occur when small blood vessels in the nose break. Common reasons for nosebleeds alone include dry air (especially cold air), upper respiratory infections, a foreign body in the nose, picking at the nose, and overuse of nasal decongestants.

Less common but serious causes may include tumors in the nose and sinus passages or a low platelet count due to conditions including liver disease, kidney disease, bleeding disorders, or blood-related cancers.

Headaches

Headaches in children are also common but rarely affect those under the age of six. Headaches may be classified as primary or secondary (due to another condition such as an infection or head trauma).

They can also be separated into tension headaches, migraine headaches, and cluster headaches. Headaches can differ in regard to the location on the head where they are felt, their quality (for example, sharp, dull, throbbing, or constant), and severity.

With headaches being so common, parents often wonder when they should worry. Headaches are usually of greater concern if:

  • The child is younger than six.
  • The child has had a previous head injury.
  • The headache awakens the child from sleep
  • The child has more than one headache per month.
  • There are additional symptoms such as neck stiffness, lethargy, lightheadedness, confusion, tremors, vision changes, numbness, muscle weakness, or fainting.

Headaches and Nosebleeds Together

When a child experiences both headaches and nosebleeds it sometimes narrows down the list of possible causes but also increases the chance that an underlying medical condition is present.

Causes

Looking at some of the potential causes of headaches and nosebleeds in children can be frightening, especially if your child has these symptoms. Though we are talking about "red flags," common things are still common and uncommon conditions are still uncommon.

It is important for parents to have an awareness of some of the more serious causes of headaches and nosebleeds, but keep in mind that allergies are much more common than brain tumors.

Allergies (Allergic Rhinitis)

Allergic rhinitis or hayfever is a common cause of both headaches and nosebleeds. With allergies, nosebleeds can be recurrent but headaches are usually relatively mild. Children with allergies may have other "atopic diseases" such as eczema or asthma and may have a family history of these as well.

Infections

Infections may also cause both headaches and nosebleeds, and sometimes fever is present as well. The common cold or sinus infections are most common, especially in children predisposed (such as those who have a deviated septum). Although uncommon, headaches and nosebleeds are classic signs of animal-transmitted infections like brucellosis and psittacosis.

Headaches due to sinus infections may be described as "heavy" and the child may feel pressure behind her eyes and nose.

Foreign Objects

A foreign body that is lodged in the nasal passages can cause these two symptoms and isn't uncommon in young children. A Lego accidentally placed in the nose can lead to nosebleeds and uncomfortable headaches. When the foreign body has been in place for some time, children often develop a thick, foul-smelling nasal discharge.

Migraine Headaches

Just as with adults, migraines in children may have symptoms other than headaches, and a significant association between migraine headaches in children and nosebleeds has been found. According to a 2015 study in the European Journal of Paediatric Neurology, 1.1% of children with migraines have nosebleeds during an attack, although some scientists believe that the incidence is higher.

Interestingly, it was found that nosebleeds often preceded the headaches by around three years, and the researchers theorized that nosebleeds may actually be a precursor to childhood migraines.

Overall, children who have recurrent nosebleeds are four times more likely to develop migraine headaches.

High Blood Pressure (Hypertension)

The thought that headaches and nosebleeds may be important symptoms of hypertension has been challenged in recent years.

According to the American Heart Association, high blood pressure doesn't cause headaches and nosebleeds unless the blood pressure is over 180/120. This severe elevation of blood pressure is referred to as malignant hypertension or a hypertensive crisis.

Unlike mild or moderate hypertension, blood pressures this high are not caused by being overweight or poor dietary choices. In children, underlying causes of severe hypertension may include some poisonings (including those related to medications), kidney disease, adrenal tumors, brain tumors, or head trauma.

Trauma

Trauma to the head, face, or nose may lead to both headaches and nosebleeds. Children who have headaches after a head injury should be evaluated immediately by a physician.

Tumors

Tumors in the nasal cavity or paranasal sinuses are very uncommon but can lead to both headaches and nosebleeds. These tumors can be benign or malignant and include many types of tumors such as angiofibromas, sarcomas, neuroblastomas, and much more.

Brain tumors, such as olfactory groove meningiomas, may also give rise to these symptoms. While brain tumors are a common concern when a child has headaches, symptoms of brain tumors usually include other neurological signs rather than headaches and nosebleeds alone.

Poisoning

Accidental ingestion of medications (especially blood thinners or anti-inflammatory drugs), household cleaners, and more may result in headaches and nosebleeds.

Vascular Disorders

There is a diverse array of conditions marked by abnormalities in blood vessels that could give rise to both headaches and nosebleeds. One such example is the genetic disorder hereditary hemorrhagic telangiectasia which can lead to arteriovenous malformations (abnormal connections between arteries and veins in the head and neck).

Another condition called vasculitis (common in connective tissue diseases such as lupus) may also cause nosebleeds and headaches.

Blood Disorders

Blood disorders ranging from hemophilia to aplastic anemia are very uncommon, but possible causes of these symptoms.

Leukemia

Leukemia, especially acute lymphocytic leukemia (the most common childhood cancer), may lead to headaches (these cancers may involve the central nervous system), and nosebleeds (due to the effect of cancer on the bone marrow resulting in a low platelet count).

Coincidence

Just because your child has headaches and nosebleeds at the same time doesn't mean they will always be related. In fact, it could simply be a coincidence that your child has both symptoms, and each could be due to an unrelated condition.

For example, your child could have a headache from sleeping in an uncomfortable position and a nosebleed from picking her nose.

When to See the Doctor

Call your pediatrician if your child's nosebleed is heavy, won't stop bleeding after 20 minutes, or is causing lightheadedness or fainting. Lethargy, confusion, or the sudden onset of a severe headache may be signs of a serious condition. If your child has a prior history of head trauma, seek immediate care.

It is important to contact your child's pediatrician about any symptom that concerns you, even if that symptom is only your "gut feeling." Trust your instincts as a parent and call.

Diagnosis

If your child is coping with nosebleeds and headaches, your pediatrician will likely first ask about a history of any head injuries. This can sometimes mean urgent care is needed.

The doctor will also ask for more detail about your child's headaches and nosebleeds including when they began, whether they are worsening or improving, and what additional symptoms you may have noted. Some of the symptoms can help narrow the possible causes are:

  • Fatigue
  • Fever
  • Bruising and/or pallor
  • Pain
  • Lightheadedness or dizziness
  • Weight loss
  • Nausea and/or vomiting
  • Neurological symptoms
  • Confusion

Your pediatrician will then perform a physical exam. Depending on her findings, she may recommend that your child see an ear, nose, and throat (ENT) specialist, such as if sinus problems or sinus infections are the suspected culprits.

Lab Tests

A number of different lab tests may be recommended:

  • Complete blood count (CBC): A CBC can determine if your child has anemia (low red blood cells) or thrombocytopenia (low platelets).
  • Chemistry panel: The comprehensive blood and urine evaluation will include kidney and liver function tests
  • Coagulation tests: Bleeding tests can determine if your child's blood is clotting normally.

Other Tests

Imaging tests may include computed tomography (CT) or magnetic resonance imaging (MRI) to evaluate the nasal cavities and sinuses or the head.

If your child's CBC is abnormal and your pediatrician is suspicious about leukemia, aplastic anemia, or other serious conditions, a bone marrow biopsy may be ordered. Bone marrow studies are typically performed if signs of anemia, thrombocytopenia, fever, lymphadenopathy (swollen lymph nodes), and hepatosplenomegaly (swollen liver and spleen) cannot be explained.

The treatment of nosebleeds and headaches will depend on the underlying cause.

A Word From Verywell

While both headaches and nosebleeds are common in children (except very young children), when the two occur together it's important to look a bit deeper. The diagnosis could be minor, such as the common cold, but could potentially be something much more serious, especially if the nosebleeds are recurrent and the headache is persistent or worsening. Of course, it could simply be a coincidence that your child has both symptoms at the same time.

In being an advocate for your child it's helpful to learn about her symptoms and the potential causes. Doing so can sometimes alert parents to report a symptom they might otherwise dismiss as unrelated or unimportant. At the same time, your intuition is a parent can be priceless. Listen to it and make sure your pediatrician does as well.

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Article Sources

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