Natural Nosebleed Relief: What Stops It, What Prevents It

Nearly everyone stops a nosebleed the wrong way — head tilted back, a wad of tissue jammed up the nostril, pressure released every thirty seconds to check. All three of those make it worse. The single most useful thing on this page is the correct technique, and it is in the first section: sit up, lean forward, pinch the soft part of the nose, and hold for a full ten to fifteen minutes without letting go. Everything after that is prevention — humidity, saline, a smear of petrolatum, aiming your nasal spray away from the septum — because the nosebleed you never have is the one you handle best. This page also gives an honest verdict on the natural remedies people ask about, including vitamin C: vitamin C fixes the nosebleeds that a lack of it caused, and none of the others.

Table of Contents

1. Stop the Bleed: the Technique Almost Everyone Gets Wrong
2. Why Noses Bleed at All
3. The Real Causes, Ranked by How Common They Are
4. Prevention That Actually Works
5. Where Vitamin C Fits — and Where It Does Not
6. Other Natural Remedies, Rated
7. Children
8. Anticoagulants and Bleeding Disorders
9. When It Is Not a Simple Nosebleed
10. Key Research Papers
11. Connections
12. Featured Videos

Stop the Bleed: the Technique Almost Everyone Gets Wrong

A nosebleed stops when a clot forms and is left alone. The technique has two jobs: squeeze the bleeding vessel shut, and do not disturb the clot. The usual approach fails at both — people pinch the hard bridge, which compresses nothing, and let go every half minute to look, which peels the new clot away.

1. Sit up and lean forward from the waist. Sitting drops the pressure in the nasal vessels; leaning forward lets blood run out where you can see it. Do not tilt the head back — that sends blood down the throat, where it is swallowed, irritates the stomach and very often comes back up as vomiting. That vomited blood is what turns a harmless nosebleed into an emergency-room visit.
2. Pinch the soft part — not the bridge. Run a finger down from between your eyes. The upper third is bone; squeezing it does nothing. Keep going until the nose gives under your finger. Beneath that soft lower two-thirds, on the septum about a centimetre inside the nostril, is where more than nine in ten nosebleeds come from. Pinch firmly so both nostrils are flattened completely shut.
3. Hold continuously for 10 to 15 minutes. Do not peek. This is the step that decides everything. Release for even three seconds and the half-built clot is disturbed and the clock starts over. Set a timer — ten minutes with a bleeding nose feels like thirty, and almost everyone lets go early. Aim for fifteen if you take a blood thinner.
4. Breathe through your mouth. Both nostrils are shut, so this is not optional. Slow mouth-breathing also keeps people calmer, and a panicking person is a person who lets go of their nose.
5. Spit the blood out; do not swallow it. Swallowed blood causes nausea and vomiting an hour later.
6. Optional: a cold pack on the bridge of the nose or the cheek. Cold constricts small vessels and is soothing. Treat it as comfort, not treatment — and never let holding it become a reason to stop pinching.
7. Optional: a topical decongestant spray. Oxymetazoline (the ingredient in Afrin and its store-brand equivalents) constricts vessels in the nasal lining and is a recognised adjunct in the 2020 AAO-HNSF nosebleed guideline. Two sprays into the bleeding nostril, then pinch as above — spray only, and do not put cotton, tissue or a pledget into your own nose. The soaked-pledget version of this is a clinic technique, because the material has to be removed by someone who can re-treat the vessel if the clot lifts with it. Not for daily use — beyond three consecutive days it causes rebound congestion. Check with a pharmacist first if you have uncontrolled high blood pressure, heart disease or an overactive thyroid, or take an MAOI antidepressant, and do not use it in children under six.
8. Protect the clot for the rest of the day. For 24 hours: no nose-blowing, no picking, no heavy lifting or straining, no hot showers, no hot drinks or alcohol, and sneeze with your mouth open.

What not to do

• Do not tilt the head back. The most common mistake, and the one that causes the vomiting.
• Do not pack tissue or cotton wool up the nose. Household tissue is fibrous; the clot grows into it, and pulling the wad out tears the clot off the vessel and restarts the bleed. Medical nasal packing is a purpose-made, non-adherent material placed and removed by a clinician — not the same thing.
• Do not put keys or ice down the back of the neck. No mechanism connects cold metal on the neck to a vessel on the nasal septum. It is folklore.
• Do not lie flat. It raises venous pressure in the head and sends blood into the throat.
• Do not check every 30 seconds. Worth saying twice: it is why most correctly-pinched noses still fail to stop.

Go to urgent care or the emergency department if bleeding continues after two full rounds of correct pressure (about 30 minutes total), if blood pours down the throat while both nostrils are pinched shut, if the bleeding is heavy or you feel faint, if it followed a blow to the face or head, or if you take an anticoagulant and it is not settling. The full list is in When It Is Not a Simple Nosebleed.

Why Noses Bleed at All

The nose warms and humidifies roughly 20,000 breaths a day, and to do that it needs a rich blood supply running very close to the surface. On the front of the septum — the wall dividing the nostrils — branches of both the internal and external carotid systems converge into a dense network called Kiesselbach's plexus, about a centimetre inside the nostril, on tissue that is thin, dried by every breath, and easily reached by a fingernail. That one patch accounts for roughly 90 to 95 percent of nosebleeds, which is why a correctly placed pinch works so reliably. The rest come from higher and further back, near Woodruff's plexus, and behave completely differently.

This is why first aid matters so much: the overwhelming majority of nosebleeds are reachable by your own thumb and forefinger. It is also the reason for the 30-minute rule — a bleed that ignores correct pressure is telling you where it is coming from.

The Real Causes, Ranked by How Common They Are

People reach for exotic explanations when the honest ranking is dominated by two boring items: dry air and fingers. Roughly in order of how often each is the answer:

1. Dry indoor air, especially winter heating. Forced-air heating drops indoor humidity to 10–20 percent. The lining dries, tiny cracks open over Kiesselbach's plexus and crust over, the crust itches, gets rubbed off, and takes a scab and a vessel with it. Desert and high-altitude climates, long flights and over-heated bedrooms do the same.
2. Digital trauma — nose-picking. The leading cause in children by a wide margin, and commoner in adults than anyone admits. It is usually a response to that crusting, and the same spot is re-injured before it heals — which is why these bleeds arrive in clusters.
3. Nasal sprays aimed at the septum. Very common and almost entirely fixable. Steroid sprays (fluticasone, mometasone, budesonide) and antihistamine sprays are excellent drugs, but the instinctive same-hand, pointing-inward technique puts them straight onto the septum, thinning the mucosa where it is already thinnest. The fix is a change of aim, not of drug — see Prevention.
4. Allergic rhinitis, colds and sinus infections. Inflamed lining is engorged and friable; add hard nose-blowing twenty times a day and vessels give way. Anyone who bleeds only in hay-fever season has their answer.
5. Septal deviation, spurs and perforations. A crooked septum disturbs airflow so one side dries faster, and the prominent edge takes the brunt. Clue: bleeds always from the same nostril.
6. Anticoagulants, antiplatelets and NSAIDs. Warfarin, apixaban, rivaroxaban, dabigatran, clopidogrel and aspirin rarely cause a nosebleed — they make an ordinary small one longer, heavier and likelier to recur. Regular ibuprofen and naproxen do the same to a smaller degree.
7. High-dose fish oil and other antiplatelet supplements. Fish oil at multiple grams of EPA plus DHA daily modestly prolongs bleeding time in the laboratory, although randomized trials have not shown a clear rise in serious bleeding; the same, less predictably, is said of high-dose vitamin E, ginkgo, garlic extract and concentrated curcumin. Treat these as worth reviewing with the prescriber rather than as an established cause.
8. Alcohol. Dilates vessels, mildly impairs platelet function, and in heavy chronic use damages clotting more broadly.
9. Vitamin C deficiency. Uncommon, but real, mechanistically clear, and worth knowing about because it is cheap to check and completely reversible. Severe deficiency degrades the collagen in vessel walls, and nosebleeds belong to that bleeding picture alongside bleeding gums, easy bruising and corkscrew hairs. It does not explain the winter nosebleed in someone who eats fruit; it can absolutely explain nosebleeds in someone whose diet has held essentially no fruit or vegetables for months. See Where Vitamin C Fits.
10. Hereditary haemorrhagic telangiectasia (HHT, Osler–Weber–Rendu). An inherited disorder in which fragile vessel malformations form on the nasal lining, lips, tongue and fingertips. Frequent, hard-to-stop nosebleeds from childhood, plus small red spots on lips or fingers, plus an affected parent or sibling, is the classic picture. It is under-diagnosed and it matters, because HHT also involves the lungs, brain and liver — see the Second International HHT Guidelines.
11. Bleeding disorders. Von Willebrand disease, haemophilia, platelet disorders, low platelets. Suspect these when nosebleeds come with heavy periods, prolonged bleeding after dental work, or a family history.
12. Tumours. Rare, and last for a reason — but persistent one-sided bleeding with one-sided blockage, facial numbness or a lump warrants a proper look inside the nose.

What about high blood pressure?

Almost everyone believes hypertension causes nosebleeds, and the evidence is far weaker than the belief. The guideline authors addressed it directly in Hypertension and Epistaxis: Why Is There Limited Guidance in the Nosebleed Clinical Practice Guidelines? — the relationship is not established well enough to make recommendations about. What usually happens is the reverse of what people assume: bleeding from your face is frightening, fear and pain raise blood pressure sharply, and the high reading is taken after the bleed started. Severely raised blood pressure with symptoms is an emergency in its own right regardless of the nose — but taking an extra dose of a blood-pressure pill during a nosebleed is unsupported and can cause harm.

Prevention That Actually Works

Recurrent nosebleeds are a moisture-and-trauma problem in most people, and the fixes are correspondingly humble. Ranked by expected benefit, with the evidence tier stated honestly — most rest on mechanism and long practice rather than large randomized trials.

1. Humidify the bedroom to 40–50% relative humidity. Mechanistically strong, formally under-studied — and the highest-yield change most people can make. Eight hours a night breathing 15%-humidity air is what cracks the septum. A cheap hygrometer tells you where you are; a cool-mist humidifier closes the gap. Do not overshoot — above about 55% you encourage mould and dust mites — and clean the reservoir.
2. Saline spray or gel, two to three times daily. Good evidence; universally recommended. Isotonic saline re-wets the mucosa, softens crusts so they come away without a scab attached, and clears allergens. Gel lasts longer and is best at bedtime. Home-made: half a teaspoon of non-iodised salt plus a pinch of baking soda in a cup (240 mL) of previously boiled and cooled, or distilled, water — never straight tap water.
3. A thin smear of petrolatum or nasal emollient at bedtime. Reasonable by mechanism; the one randomized trial found it inferior to cautery. A pea-sized dab wiped just inside the nostril along the septum holds moisture in overnight. In a randomized controlled trial in recurrent epistaxis, liquid paraffin plus antiseptic cream was tested head-to-head against Nd:YAG laser photocoagulation and lost: at 12 weeks, 40% of the emollient group were free of bleeding against 85% of the laser group, and the authors concluded laser was the preferable treatment. So an emollient is a sensible, near-free first step that worked for a substantial minority — not a substitute for cautery once bleeding keeps recurring. Thin smear only, and avoid repeated use in anyone at risk of aspirating it.
4. Re-aim your nasal spray. Good evidence, and free. The trick ENT clinics teach: spray the right nostril with your left hand and the left nostril with your right, aiming outward toward the same-side ear rather than straight back or inward. That puts the drug on the outer wall, where you want it, and away from the septum, where the bleeding is. Do not sniff hard as you spray.
5. Treat the itch that drives the picking, and keep nails short. Obvious mechanism, especially in children. Nobody picks a comfortable nose. Break the cycle at the moisture end and blunt the damage at the fingernail end. Scolding is not a treatment.
6. Treat the underlying rhinitis. Good evidence. Controlling allergy reduces both the fragility and the hard nose-blowing. Blow gently, one nostril at a time.
7. Protect a fresh clot for 24 hours. No forceful blowing, picking, straining, hot showers or alcohol. Most "it came back" stories are a clot disturbed within hours.
8. Review anticoagulants and high-dose fish oil with the prescriber — never stop them yourself. There may be a dose to reconsider, a range that has drifted, or a supplement that is simply unnecessary. Stopping an anticoagulant unilaterally risks a stroke or clot, far worse than a nosebleed.
9. Consider cautery for the stubborn ones. Good evidence; a clinic procedure, not a home remedy. When one visible vessel keeps reopening, an ENT clinician seals it with silver nitrate or electrocautery in minutes under local anaesthetic. The 2021 New England Journal of Medicine review lays out this stepwise escalation.

For children, the practice guideline on epistaxis in children makes the same case: humidification, emollient or antiseptic ointment, nail care and reassurance are the mainstays.

Where Vitamin C Fits — and Where It Does Not

Natural-health writing usually goes wrong here in one of two directions — promising that vitamin C fixes nosebleeds, or dismissing the connection outright. Neither is right. The accurate version is narrow and genuinely useful.

The part that is true

Vitamin C is the required cofactor for prolyl hydroxylase and lysyl hydroxylase, the enzymes that modify collagen as it is built — the modifications that let three collagen chains twist into a stable triple helix. Without vitamin C the chains are made but under-hydroxylated, the helix is unstable, and the result is broken down instead of built into tissue. Collagen is the structural rope of blood-vessel walls, so when it fails, small vessels become fragile and rupture under stresses healthy vessels shrug off.

That is why bleeding is the signature of scurvy: bleeding gums, unexplained bruises, blood under the skin around hair follicles — and nosebleeds. That picture is still documented in modern case reports of unrecognised scurvy in adults. Deficiency is also still found in children: a children's-hospital series identified 32 cases, almost all in children with an underlying condition such as transfusional iron overload, a neurological disorder or recent chemotherapy rather than a poor diet — and found the diagnosis was repeatedly missed. And the correction is dramatic: give vitamin C back to a genuinely deficient person and the bleeding tendency reverses within days to a few weeks, because collagen synthesis restarts as soon as the cofactor is available. It costs almost nothing.

The part that is not true

None of that says anything about the ordinary nosebleed, and vitamin C deficiency is an uncommon cause of epistaxis — nothing like one in twenty. The overwhelming majority of nosebleeds are dry air and trauma to a septum whose collagen is perfectly normal. If your nose bleeds because winter heating dried your septum, because you picked at a crust, because your steroid spray points at the wrong wall, because you have a septal spur, because you take apixaban, or because you have HHT, then your collagen is fine and vitamin C has nothing to correct. Three things deserve to be said plainly:

• Vitamin C does not stop an active nosebleed. Nothing supports that, and no plausible mechanism works on a timescale of minutes. Pressure stops nosebleeds.
• Vitamin C is not in the 2020 AAO-HNSF nosebleed guideline — not as treatment, not as prevention. It is absent because there is no modern trial evidence to put in.
• The only published reports that ever gave vitamin C or citrus bioflavonoids for nosebleeds are uncontrolled case series from the 1950s — a 1956 series of a citrus flavonoid plus vitamin K, and a 1959 series of hesperidin plus ascorbic acid. They are history, not current practice.

The historic bioflavonoid trials, and why they settle nothing

In the two decades after vitamin C was isolated there was an energetic research programme around "capillary fragility" — the idea that ascorbic acid plus citrus bioflavonoids (hesperidin, rutin) strengthened small vessels. Studies gave the combination to people with easy bruising and nosebleeds and reported improvement, including a 1956 report on epistaxis treated with a citrus flavonoid compound plus vitamin K and a 1959 report on hesperidin and ascorbic acid in menopausal patients.

Read them as historical documents. They predate randomization, blinding, placebo control, pre-specified outcomes and modern statistics — typically small, uncontrolled series in which a physician gave a supplement and recorded that patients seemed better. That is exactly the design that mistakes the natural course of a recurring, self-limiting condition for a treatment effect: nosebleeds come in clusters and then stop, the heating goes off in spring, and anything given during a bad patch appears to work. No modern randomized trial of vitamin C or bioflavonoids for ordinary nosebleeds exists. Not a negative one — none at all.

The practical rule

The honest one-line version is worth remembering: vitamin C fixes the nosebleeds that a lack of it caused, and none of the others. So the question is not "should I take vitamin C" but "am I actually deficient?" Ask for a plasma ascorbate level — deficiency is a value below about 11.4 µmol/L (0.2 mg/dL), and roughly 11.4–23 µmol/L counts as low — if your nosebleeds come packaged with any of these:

• Swollen, purplish gums that bleed when you brush.
• Bruises appearing without remembered injury, especially on shins and forearms.
• Tiny red-purple dots around hair follicles, or body hairs growing out coiled and corkscrew-shaped.
• Old scars reopening, or new cuts healing badly; deep aching in the legs; unexplained fatigue.
• A diet with almost no fruit or vegetables for months — food insecurity, alcohol use disorder, restrictive eating disorders, food selectivity in autistic children, isolated older adults, severe inflammatory bowel disease, after bariatric surgery.

If none of that is you, vitamin C is not your answer and humidity, saline and spray technique are. The mechanism, diagnosis, repletion dosing and scurvy differential are covered in full on the companion page: Vitamin C Deficiency: Nosebleeds and Capillary Fragility.

Getting vitamin C from food

About 10 mg a day prevents scurvy outright, and the adult RDA of 75–90 mg (smokers need about 35 mg more) is met by a single serving of most foods below. The depletion–repletion work behind that RDA showed stores approach saturation around 100–200 mg a day, with absorption falling off sharply above that — a good argument for food over large pills. Whole foods also supply the bioflavonoids the 1940s researchers were chasing, free and with no claims attached. Large supplemental doses are not harmless. Above roughly 1,000–2,000 mg a day the unabsorbed remainder draws water into the gut and causes bloating, cramping and diarrhoea, and because ascorbate is metabolised in part to oxalate, high doses raise urinary oxalate and can raise kidney-stone risk in people who already form stones or have reduced kidney function. The adult tolerable upper intake level is 2,000 mg a day, and correcting a genuine deficiency needs nothing remotely close to that.

Vitamin C is water-soluble and heat-sensitive, so raw and lightly cooked servings retain the most. A red pepper, a kiwi or a handful of strawberries most days makes deficiency essentially impossible.

Other Natural Remedies, Rated

Four ratings: Helpful (do this), Plausible (modest or comfort-level benefit), No Good Evidence (traditional or historic, unproven — not necessarily harmful), and Avoid (actively counterproductive).

Children

Nosebleeds in children are so common they are close to normal. They peak in the preschool and early school years, cluster in winter, and are overwhelmingly the same boring combination: a dry, crusted septum plus a curious finger. Most children outgrow them by the mid-teens. The technique is identical, scaled down and made calmer:

1. Stay unbothered. Children take their cue from the adult, and crying raises venous pressure in the head, which makes bleeding worse.
2. Sit the child upright on your lap, leaning forward over a bowl or towel. Not lying down, not head-back.
3. You do the pinching. Children cannot hold steady pressure. Pinch the soft part below the bony bridge, firmly, both nostrils flattened shut.
4. Hold 10 minutes by the clock, without peeking. Distraction is the whole trick — a screen, a story or a song buys the cooperation.
5. Encourage spitting, not swallowing — swallowed blood is why so many children vomit an hour later and frighten everybody.
6. Afterwards: quiet activity for the day, no blowing or picking, and start the prevention routine that night.

Prevention is nail care plus moisture, and it works: trim and smooth the nails, saline two or three times daily, a pea-sized dab of petrolatum or antiseptic ointment at bedtime, a bedroom humidifier over the heating season, and treatment for hay fever if it is there. Do not scold the picking — give the nose something better to feel like and the picking mostly stops on its own.

When a child's nosebleed does warrant a workup

• Under 2 years old — genuinely unusual at this age; look for trauma or a foreign body.
• Always the same nostril with blockage, foul one-sided discharge or a bad smell — classic for an object pushed up the nose.
• Frequent, heavy or hard-to-stop bleeds, or bleeding beyond 20–30 minutes of correct pressure.
• Nosebleeds with easy bruising, bleeding gums, prolonged bleeding after dental work, or heavy periods in an adolescent — screen for von Willebrand disease.
• A family history of frequent nosebleeds, or small red spots on lips or fingertips — think HHT.
• A pale or tired child — see Iron, because repeated blood loss from the nose really can cause iron-deficiency anaemia.
• An adolescent boy with recurrent heavy one-sided bleeding and nasal obstruction — uncommon, but this needs imaging and an ENT opinion.
• Any suspicion that the injury pattern does not fit the story.

Anticoagulants and Bleeding Disorders

If you take a blood thinner, one message outranks everything else here: do not stop it because your nose bled. Anticoagulants prevent strokes in atrial fibrillation, treat deep vein thrombosis and pulmonary embolism, and protect mechanical heart valves. Stopping abruptly trades a risk measured in disability and death for one usually measured in an inconvenient evening. The 2020 guideline treats anticoagulation as something the clinician manages, not something the patient interrupts.

• Same technique, longer. Fifteen uninterrupted minutes rather than ten, ready to repeat once. It will take longer to stop — that is the drug working, not a catastrophe.
• Use the topical decongestant early. Two sprays of oxymetazoline into the bleeding nostril before you start pinching is a reasonable first move here rather than a last resort — sprayed only, with nothing packed into the nose.
• Be more aggressive about prevention. Humidifier, saline two or three times daily, nightly emollient, no picking, gentle blowing.
• Have the conversation with the prescriber, promptly. Worth reviewing: whether an INR on warfarin has drifted above range; whether a direct oral anticoagulant dose matches current kidney function, weight and age; whether you are on an anticoagulant and an antiplatelet when only one is needed; whether a regular NSAID can be swapped for something gentler; whether a high-dose fish-oil supplement still earns its place.
• Ask about cautery. Sealing the culprit vessel is often the definitive answer, and it lets the anticoagulant continue untouched.
• Go in early if it is not settling. Thirty minutes without control, blood down the throat, faintness or a racing heart is an emergency visit, and a reasonable one.

The same principles apply to inherited bleeding disorders, with one addition: if you have von Willebrand disease, haemophilia, a platelet disorder or a low platelet count, your haematology team's plan takes precedence over general advice. Nosebleeds are often the first and most frequent symptom of von Willebrand disease, so if yours come with heavy periods, prolonged bleeding after dental extractions and affected relatives, ask to be tested. And because repeated blood loss adds up, anyone with frequent or heavy nosebleeds should have a periodic blood count and iron studies.

When It Is Not a Simple Nosebleed

Most nosebleeds need a technique, not a doctor. These are the situations where that is not true.

Get emergency care now

• Bleeding that does not stop after two complete rounds of correct 10–15 minute pressure.
• Heavy, fast bleeding, or a large volume lost.
• Blood running down the back of the throat while both nostrils are pinched shut — the signature of a posterior bleed.
• Feeling faint, dizzy, breathless, clammy, or a racing heart.
• A nosebleed after significant head or facial injury, especially with visible deformity or clear watery fluid mixed with the blood.
• Difficulty breathing, or choking on blood.
• A nosebleed on an anticoagulant that is not coming under control.

Make an appointment

• Nosebleeds more than once a week, or a run of them over a few weeks despite good prevention.
• Bleeding always from the same nostril, especially with one-sided blockage, facial pain, numbness or a lump.
• Nosebleeds plus bleeding elsewhere — gums, easy bruising, blood in urine or stool, heavy periods, prolonged bleeding after minor cuts or dental work.
• Nosebleeds plus anaemia symptoms: unusual fatigue, pallor, breathlessness on stairs.
• Nosebleeds in a child under 2 years old.
• Nosebleeds plus unexplained weight loss, fevers, night sweats or swollen lymph nodes.
• Nosebleeds plus the deficiency cluster — bleeding gums, easy bruising, corkscrew hairs, poor wound healing, and a diet with essentially no fruit or vegetables. Ask for a plasma ascorbate level; see Vitamin C Deficiency: Nosebleeds and Capillary Fragility.
• Recurrent nosebleeds plus telangiectasias plus family history. Frequent spontaneous nosebleeds, small red or purple spider-like spots on the lips, tongue, face or fingertips, and a first-degree relative with the same pattern should prompt a question about hereditary haemorrhagic telangiectasia. HHT is diagnosed on those clinical criteria and confirmed genetically, and screening for lung, brain and liver vascular malformations is part of the Second International HHT Guidelines. Many people with HHT spend decades being told their nosebleeds are nothing.

Key Research Papers

Epistaxis: clinical care and guidelines

1. Tunkel DE, et al. Clinical Practice Guideline: Nosebleed (Epistaxis). Otolaryngology–Head and Neck Surgery. 2020 Jan — the current American guideline. Vitamin C does not appear in it.
2. Epistaxis. New England Journal of Medicine. 2021 Mar 11 — clinical review; escalation from pressure to cautery to packing.
3. Hypertension and Epistaxis: Why Is There Limited Guidance in the Nosebleed Clinical Practice Guidelines? Otolaryngology–Head and Neck Surgery. 2020 Jan — why blood pressure is not established as a cause.
4. Practice Guideline: Epistaxis in Children. Journal of Pediatric Health Care. 2015 Sep-Oct — the conservative paediatric approach.
5. A prospective randomised controlled trial of Nd:YAG laser photocoagulation versus liquid paraffin plus antiseptic cream in the treatment of recurrent epistaxis. Clinical Otolaryngology. 2012 Aug — laser was superior at 12 weeks (85% vs 40% bleed-free); the emollient arm is nonetheless the only randomized data there is on a simple emollient regimen.
6. Second International Guidelines for the Diagnosis and Management of Hereditary Hemorrhagic Telangiectasia. Annals of Internal Medicine. 2020 Dec 15 — nosebleeds with telangiectasias and family history.

Vitamin C deficiency and bleeding

1. Unrecognised scurvy. BMJ. 2009 Sep 17 — how deficiency still presents, and how easily it is missed.
2. Modern American scurvy — experience with vitamin C deficiency at a large children's hospital. Pediatric Radiology. 2017 Feb — 32 paediatric cases, almost all with a predisposing medical condition rather than a poor diet; imaging findings, and how often the diagnosis is missed.
3. Vitamin C pharmacokinetics in healthy volunteers: evidence for a recommended dietary allowance. Proceedings of the National Academy of Sciences USA. 1996 Apr 16 — the work behind the modern RDA.
4. Regulation of collagen biosynthesis by ascorbic acid: a review. Yale Journal of Biology and Medicine. 1985 Nov-Dec. PMID 3008449 — ascorbate as cofactor for prolyl and lysyl hydroxylase.

The historic bioflavonoid literature (context only — pre-modern methods)

1. Epistaxis; treatment with a new citrus flavinoid compound combined with vitamin K. Eye, Ear, Nose & Throat Monthly. 1956 Nov. PMID 13365640 — one of very few papers ever to test a citrus-bioflavonoid preparation for nosebleeds, and it was given with vitamin K rather than vitamin C. Uncontrolled and unblinded.
2. Nocturnal leg cramps, easy bruisability and epistaxis in menopausal patients: treated with hesperidin and ascorbic acid. Delaware State Medical Journal. 1959 Jan. PMID 13619318 — the "capillary fragility" era. History, not evidence.

Live PubMed Searches

1. Epistaxis management, randomized trials
2. Epistaxis in children — prevention
3. Intranasal corticosteroid spray and epistaxis
4. Epistaxis and direct oral anticoagulants
5. Hereditary haemorrhagic telangiectasia and epistaxis
6. Ascorbic acid deficiency and capillary fragility

Connections

• All Remedies
• Epistaxis (Nosebleed) — the clinical condition page: types, workup and medical treatment
• Ear, Nose & Throat Conditions — the wider ENT section, including rhinitis and sinus disease
• Vitamin C Deficiency: Nosebleeds and Capillary Fragility — the deep dive on the one nutritional cause worth checking
• Vitamin C Deficiency (Scurvy) — the full deficiency picture, from bleeding gums to poor wound healing
• Vitamin C — requirements, food sources, absorption and supplementation
• Vitamin K — the clotting-factor vitamin, and why it interacts with warfarin
• Iron — repeated nosebleeds are a real cause of iron-deficiency anaemia
• Hydration — whole-body moisture, and why mucous membranes complain first
• Wound Healing — collagen, clotting and the nutrients tissue repair depends on

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