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.

Nosebleeds and Headaches

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

Nosebleeds (Epistaxis)

Nosebleeds are common in mid-childhood, with the incidence highest in children between the ages of three and eight. Roughly 56 percent of children between the ages of six and ten 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 in Children

Headaches in children are also common overall but are relatively uncommon in children younger than six years old. 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 has had a previous head injury if the headache awakens the child from sleep, if the child has more than one headache per month, and if there are any associated symptoms such as neck stiffness, lethargy, or any neurological signs. Headaches in a child younger than six are also of greater concern.

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 of Headaches and Nosebleeds

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's 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.

Possible causes of headaches and nosebleeds include:

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 a 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). Much less common, headaches and nosebleeds are often classic symptoms in children with brucellosis, psittacosis, and in many parts of the world, dengue fever.

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

Foreign Body in the Nose or Nasal Passages

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. In a 2015 study, 1.1 percent of children with migraines had nosebleeds during the attack, but this may be more common. An older study found nosebleeds to occur in 36 percent of children with migraines (compared with 11 percent in the control group).

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 blood pressure is higher than 180/120. This severe and serious degree of elevated blood pressure is referred to as malignant hypertension or 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.

Poisonings

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

Disorders of Blood Vessels

There is a diverse array of conditions marked by abnormalities in blood vessels that could give rise to both headaches and nosebleeds. Examples can include the inherited syndrome called hereditary hemorrhagic telangiectasia, abnormalities in the connections between arteries and veins in the head and neck (AV malformations), and vasculitis related to connective tissue diseases such as lupus.

Blood Dyscrasias

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, she 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 has a nosebleed that is bleeding heavily and/or won't stop after 20 minutes, or if your child feels lightheaded or faint. Likewise, a severe headache, especially one of sudden onset, or lethargy and confusion may be a sign that something is serious. If your child has a history of a head injury you should seek care immediately.


It's 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. She 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 these other symptoms may help you and your doctor narrow down the possible causes:

  • 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 if an infection is present (based on the white blood cell count and types of white blood cells) and if her platelet count is normal. Anemia can be an important finding in more than one way. Children with recurrent nosebleeds may develop anemia due to blood loss (often iron deficiency anemia). But anemia may also occur with conditions such as aplastic anemia or even leukemia.
  • Chemistry panel with kidney and liver function tests
  • Coagulation tests: Bleeding tests can determine if your child's blood is clotting normally.

Imaging Tests

Imaging tests may include a CT scan or MRI to evaluate the nasal cavities and sinuses or the head.

Procedures

If your child's CBC is abnormal and your pediatrician is suspicious about a condition such as leukemia or aplastic anemia, a bone marrow study may be done.

Treatment

The treatment of nosebleeds and headaches will depend very much 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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