Should You Tilt Your Head Back or Forward to Stop a Nosebleed?

A nosebleed (epistaxis) is a fairly common problem that is often treated at home. One immediate reaction when this occurs is to tilt your head back so you won't drip blood, but it is better to sit up straight and keep your head in a neutral position (rather than tilted backward or way forward) when working to stopping a nose bleed.

While it may reduce the amount of blood that comes out of your nose, tilting your head back allows the blood to run down the back of your throat. This can result in nausea, vomiting, and diarrhea. A slight tilt forward is OK, but going too far (e.g., leaning down to your knees) can position your heart above your head, which can encourage more bleeding.

What to Do When You Have a Nosebleed

Rather than tilt your head back, the recommendation is to:

1. Sit in a chair.
2. Keep your body and head upright rather than tilted backward or bent far forward.
3. Pinch your nostrils together by gently pressing on each side of your nose (just below the bridge).
4. Keep pressure on your nostrils for at least five minutes, and a full 10 minutes if possible before checking to see if bleeding has stopped.

If available, you can use a cloth or tissue to catch any blood, but don't pack your nose with gauze or tissue. You can apply a cold compress to the bridge of your nose if helpful.

After the bleeding stops, maintain an upright body position and avoid bending over. Also, avoid blowing your nose.

When to See a Healthcare Provider/Go to the Hospital

Nosebleeds are rarely a medical emergency. However, on occasion, you may need help from a medical professional for your nosebleed.

You can determine the severity of your nosebleed by asking yourself the following questions:

• Has your nose been bleeding for 20 minutes and won't stop despite you trying the first aid steps listed above?
• Are you bleeding rapidly or have you lost more than a cup of blood?
• Are you having other symptoms as a result of the bleeding, such as pale skin, confusion, chest pain, or difficulty breathing?
• Is blood running down the back of your throat? (posterior nosebleed)
• Is the bleeding caused by a traumatic facial injury (like a broken nose), a car accident, or a blow to the head?
• Are you taking anticoagulants (blood thinners)?

If you answer "yes" to any of these, you should seek medical attention immediately. Call 911 or ask a friend or family member to drive you to the emergency department. Driving while you are actively bleeding could result in passing out at the wheel and being involved in a dangerous accident.

If you have a nosebleed that you managed to stop, contact your healthcare provider for further advice if you are taking anticoagulants (blood thinners), you started a new medication recently, you recently had nasal or sinus surgery, or you have a known condition such as a nasal or sinus tumor or polyps.

Causes and Prevention

Genetic causes of nosebleeds, like hereditary hemorrhagic telangiectasia, are obviously unavoidable. And if you are on a blood thinner, which impedes clotting, you may not be able to stop taking your medication.

But most other causes of nosebleeds can be influenced by changes that are within your control:

• Refrain from picking your nose and keep nails short with rounded edges.
• Work to manage your allergies and do your best to prevent colds to avoid having to blow your nose frequently.
• Try using a cool mist humidifier at night, particularly if you live in an area with low humidity.
• Use a saline nasal spray to keep your nasal passages hydrated.

If you play sports or have a physical job, be sure to wear proper protective equipment (if applicable) to prevent facial trauma.

That said, some people experience frequent nosebleeds that sometimes don't have an obvious cause (such as being bumped in the nose).

You can often stop these nosebleeds, but to further prevent them from recurring, you should talk to your healthcare provider.