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In many TV shows from medically-related to not, people get nosebleeds when they're working too hard or "deathly" ill. I'm wondering if this real or just dramatized. If it happens to be real, is it only for physical activity and health or possibly from mentally strenuous activity too?

Ultimately, how does the nosebleed typically occur?

4

Blood vessels do pop or rupture at times, causing a nosebleed.

So what exactly in the sick and stressed cause them to have more nosebleeds?

In regards to the sick, medicines that cause you to bleed more easily, including aspirin and anticoagulants such as warfarin and heparin will tend to cause higher rates of nosebleeds. (1)

Now with regards to stress, there is debate (2). A study published in 1977 found no correlation (3), but a more recent study in 2012 (4) suggests that high blood pressure is associated with nosebleeds. If this is the case, researchers theorize that since high levels of stress cause high blood pressure and constrict blood vessels (5), then it is possible for stress to cause these vessels in our nose to rupture.

These sources seem to indicate that both stress and certain medications can in some situations cause nosebleeds.

Sources:

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