It was a typical morning. My mother was getting ready; this was her usual routine: bustling around the house. When she suddenly stopped and shouted, blood was oozing from her nose. As kids, my siblings and I were terrified. We scrambled to help, but it wasn't until later that we learned the cause of that alarming moment: high blood pressure. That day was our first lesson in the silent yet powerful effects of hypertension. Nosebleeds, or epistaxis, are common, and nearly everyone experiences at least one in their lifetime.

While most are minor and often caused by dry air or irritation, some can signal underlying health concerns. One recurring question is whether high blood pressure causes nosebleeds or is merely coincidental.

Where Exactly Does a Nosebleed Occur?

The nose is covered by a rich plexus of small blood vessels, making it prone to bleeding. Most nosebleeds are anterior in origin, occurring at the front of the nose, and are relatively benign. They often occur because of irritants such as dry air, frequent nose-blowing, or trauma.

On the other hand, posterior nosebleeds are caused by a source that is located deeper within the nasal cavity. They are less common but more severe, as the blood tends to flow backward into the throat, making them more difficult to control. Common causes of posterior nosebleeds include trauma, medical conditions, or high blood pressure.

Connection Between Nosebleeds and High Blood Pressure

Hypertension is the condition whereby the pressure of blood against the arterial walls is consistently too high. Over time, this may damage the fine blood vessels in the nose, causing them to rupture more easily.

Significant studies have shown a strong relationship between hypertension and severe cases of nosebleeds necessitating urgent care. A certain study showed that patients diagnosed with high blood pressure had 2.7-fold increased chances of having nosebleeds that were not slight.

However, it should be noted that mild hypertension by itself does not cause nosebleeds. Nosebleeds are more likely to happen during a hypertensive crisis when the blood pressure suddenly rises to above 180/120. A hypertensive crisis can also have other symptoms such as a severe headache, shortness of breath, and anxiety. Therefore, it is considered a medical emergency.

Why Does Hypertension Increase the Risk?

Chronic hypertension makes the walls of blood vessels weaker and less elastic, which easily causes them to tear. In the nose, this is especially vulnerable because the blood vessels are close to the surface. Sudden surges in blood pressure, such as in a hypertensive crisis, can cause tears in these weakened vessels, resulting in nosebleeds.

While hypertension is a contributing cause, nosebleeds occur infrequently as the only manifestation of high blood pressure. This makes regular monitoring for blood pressure all the more crucial, as hypertension has the reputation of being the "silent killer" since people often do not present symptoms until the disease has run its course.

Other Causes of Nosebleeds

• Dry Air: Cold weather or house heating dries out membranes that line the nose, hence susceptible to cracking.
• Trauma: Blows in the nose, nose picking or excessive nose blowing can traumatize blood vessels.
• Intrinsic Disease: Liver disease and kidney disease and drug therapy that affect clotting such as blood thinners enhance the risk of nose bleeding.
• Foreign Bodies: Children especially tend to insert objects up their noses, which can be irritating and bleed.
• Allergies or Infections: Chronic nasal inflammation resulting from allergies or colds causes irritation to the nasal mucosa.

Managing Nosebleeds at Home

For most nosebleeds, you can manage them yourself at home:

1. Sit up and lean slightly forward to prevent swallowing blood.

2. Press your nostrils together for at least 10 minutes.

3. Use a cold compress on the bridge of your nose to constrict blood vessels.

4. If the bleeding continues, use a nasal decongestant spray.

Consult a doctor if the bleeding persists beyond 20 minutes, is heavy, or follows a head injury.

Preventing Nosebleeds

Preventive measures can decrease the incidence of nosebleeds:

• Use a humidifier to maintain moisture in the air.
• Apply saline sprays or gels to keep nasal passages hydrated.
• Avoid nasal trauma by being gentle when blowing your nose.

For patients with hypertension, managing blood pressure is the best way to minimize the risk of complications. A combination of lifestyle changes, such as maintaining a healthy diet, regular exercise, and prescribed medications, can help keep blood pressure in check.

When to Worry About Nosebleeds

Most nosebleeds are harmless, but they can sometimes be signs of an underlying health condition. In adults with high blood pressure, frequent or severe nosebleeds should never be ignored. A health provider should be consulted in order to rule out any serious conditions and ensure appropriate treatment.

Regular check-ups, a healthy lifestyle, and awareness about the relationship between nosebleeds and high blood pressure would go a long way to protect your health. Indeed, prevention is always better than cure.

Epistaxis and hypertension. Post Graduate Medical Journal. 1977

Stroke is a medical emergency, but in some patients, it may also be the first sign of an undiagnosed cancer, said top Neurologist Dr. Vinit Suri on World Stroke Day.

In an exclusive interview with HealthandMe for World Stroke Day, Dr. Suri, Senior Consultant Neurologist and Academic Coordinator at Indraprastha Apollo Hospital, New Delhi, explains the link between cancer and stroke, the warning signs that need urgent attention, and how patients can reduce their risk.

He noted that cancer and its treatment can also increase stroke risk, while a stroke may sometimes prompt doctors to investigate an underlying malignancy.

The noted expert also highlighted warning signs which may point to an underlying malignancy, and how cancer patients can reduce their risk and manage recovery.

How Are Cancer And Stroke Linked?

Also read: Recreational Drugs, Steroids & Birth Control: Expert Explains Why Strokes Are Arriving Decades Earlier

Dr Suri said cancer and stroke can overlap in three ways: cancer patients may have conventional risk factors such as hypertension and diabetes; cancer itself can increase blood clotting; and certain treatments can raise stroke risk.

“Cancer patients have double the risk of having a stroke compared to their age-matched individuals,” Dr Suri said.

He estimated that 10% to 15% of stroke patients may have cancer or cancer treatment as the underlying cause. Sometimes, a stroke is the first sign of an undiagnosed malignancy, known as a sentinel stroke. Thus, identifying the cause is important to prevent recurrent strokes.

Which Cancers Are Associated With Stroke?

Q. What Warning Signs May Point To An Undiagnosed Cancer?

Dr. Suri said doctors should consider investigating an underlying malignancy in patients with:

• Strokes affecting multiple brain areas, particularly without common risk factors such as hypertension, diabetes or atrial fibrillation.
• Recurrent strokes despite preventive treatment.
• Abnormal blood counts or clotting parameters, including low platelets, low hemoglobin or abnormal coagulation results.
• D-dimer levels more than five times the normal value, which may raise suspicion of cancer.

Investigations may include D-dimer testing, tumor markers such as prostate-specific antigen (PSA), other cancer biomarkers and whole-body PET-CT, said the noted neurologist.

A stroke may reveal cancer even without obvious cancer-related symptoms. Emergency stroke treatment must take priority, followed by investigations to identify the cause and prevent recurrence, he added.

Q. Which Stroke Symptoms Should Cancer Patients Never Ignore?

Read More: World Stroke Day: What Is BE FAST? Stroke Warning Signs To Watch For

Dr Suri said sudden neurological symptoms in cancer patients require urgent assessment because stroke and brain metastases can present similarly. Brain metastases may also cause seizures and one-sided weakness.

He recommended BE FAST to recognize possible stroke symptoms:

• B — Balance: Sudden loss of balance.
• E — Eyes: Sudden vision problems.
• F — Face: Facial asymmetry.
• A — Arms: Arm weakness or downward drift.
• S — Speech: Slurred speech or difficulty speaking.

Anyone experiencing these symptoms should seek emergency care, the expert said.

“Time is brain,” he said. Clot-dissolving drugs may be given within four and a half hours in eligible patients, while clot-removal procedures may be possible within six to 24 hours, depending on the patient.

CT scans may be sufficient in many cases, but MRI may help distinguish a stroke from brain metastases.

Q. How Can Cancer And Its Treatment Increase Stroke Risk?

Dr Suri said that some chemotherapy drugs and hormonal therapies for breast and prostate cancers can increase blood clotting.

Radiation to the neck may cause narrowing, scarring and fibrosis in the carotid arteries, potentially contributing to strokes years later.

READ: 1 in 7 Stroke Patients In India Are Under 45; Hypertension Leads Risk Factors: ICMR Study

Q. How Can Cancer Patients Reduce Their Stroke Risk?

Dr Suri advised people to control blood pressure, diabetes, abnormal cholesterol and obesity through physical activity and by avoiding a sedentary lifestyle.

Age, male sex and family history are the non-modifiable risks, while other risk factors include heart disease, smoking, alcohol use, chewing tobacco and drug abuse, which can contribute to strokes even in young people.

Dr Suri described hypertension as the most important modifiable risk factor and a major cause of ischemic and hemorrhagic strokes. He recommended regular blood pressure checks, reducing salt intake, walking and taking prescribed medication. He also stressed diabetes management and identifying atrial fibrillation, which can cause strokes affecting multiple brain blood vessel territories in older adults.

Oncologists should consider stroke risk when choosing treatments, particularly for patients with pancreatic or lung cancer and other adenocarcinomas associated with increased clotting risk, he said.

Treatment may involve addressing the underlying cancer through chemotherapy or surgery and preventing further clots. Warfarin may not work in some cases, and doctors may consider direct oral anticoagulants (DOACs) or low-molecular-weight heparin.

Q. How Do Cancer And Stroke Together Affect Recovery?

Dr Suri said having both conditions can worsen prognosis because stroke can cause death or long-term disability, while cancer may reduce life expectancy.

“When these two double whammies are happening together, the outlook becomes much, much graver,” he said, adding neurologists and oncologists must work together to adjust treatment.

“Both of them have to be involved together as a team to plan and modify both the cancer therapy as well as the stroke therapy,” he said.

Some medicines that increase stroke risk may need to be withdrawn. Blood thinners must be selected with the oncologist because certain chemotherapy drugs can rapidly lower platelet and white blood cell counts.

Cancer does not automatically prevent stroke rehabilitation, Suri said, although severe weakness or frailty may limit participation.

“Cancer is not likely to interfere with the rehabilitative processes unless and until it has made the patient very weak and frail,” he said.

Q. Can Cancer And Stroke Occur In Young People?

Yes, Dr Suri said. Both can occur at any age, although their causes and cancer types may differ across age groups.

“Stroke can occur even in very young children,” he said, noting that infants may have strokes due to arteriopathies and other conditions. Both conditions become more common with age, but neither has a lower age limit.

Ever since artificial intelligence became a part of our lives, we have fallen into the habit of quickly firing up that chat box and typing our biggest worries, darkest thoughts among many other things. But it has become important to stop and ponder whether AI is really producing the most useful and viable solutions for us.

A recent study published in NEJM AI suggests that artificial intelligence systems may recommend more expensive medical care than doctors. The findings said that AI-generated care plans may cost more than three times as much as doctors’ recommendations.

The researchers compared recommendations from 24 artificial intelligence systems with the recommendations by physicians across 200 outpatient and emergency department visits.

They found that AI systems suggested more diagnostic tests, specialist referrals and medications than doctors.

The average estimated cost of care recommended by 20 general-purpose AI systems was USD 314 per visit compared to USD 97 for physicians’ plans. That was equal to a 3.2-fold difference.

How Did Researchers Compare AI’s Recommendations With Doctors’?

The researchers used 200 de-identified patient history and notes from outpatient and emergency department visits, sourced from MTSamples, a public collection of clinical documentation.

They gave the notes to 24 AI systems, including 20 general-purpose large language models and four specialised medical AI systems. Each system produced an assessment and plan based on that information. Researchers then compared these recommendations with the original physician’s documented plan.

The researchers estimated costs using 2026 US Medicare rates. The cost comparison included diagnostic tests and specialist referrals. New medications were counted separately. The results showed that AI-generated plans recommended more investigations and specialist consultations, increasing the estimated cost of care.

Also read: Woman With Epilepsy Dies After Following ChatGPT’s Advice To Stop Medication: Why AI Cannot Replace A Doctor

AI Recommended More Tests Even When Doctors Ordered None

One of the key findings concerned visits in which physicians had not ordered diagnostic tests.

Doctors had recommended no diagnostic testing in approximately 66% of the encounters. Across these visits, the AI systems consistently suggested tests, often including standard panels of blood investigations.

Overall, diagnostic testing recommended by the general-purpose AI systems cost an estimated USD 176 per visit compared to USD 71 for doctors’ plans.

AI systems also recommended specialist referrals and new medications more frequently than doctors. The researchers saw an average of 1.14 new medications per visit across the AI systems, compared to 0.59 in physicians’ plans.

These findings suggest that AI-generated care plans may favour additional investigations and interventions.

Also read: AI Diet Advice Turns Dangerous: ChatGPT Plan Lands Man In ER With Bromide Poisoning

Can Changing Prompts Help Obtain Less Expensive Medical Care From AI?

The researchers also examined whether changing the prompts given to AI systems could reduce the cost of their recommendations.

Prompts containing savings and budget-friendly suggestions reduced the estimated cost difference, but did not eliminate it. The cost ratio fell from 3.2 times physicians’ plans to 2.5 times when systems were specifically instructed to recommend cost-friendly tests and medicines.

When the systems were asked to recommend a plan that was both affordable and clinically sound, the ratio fell further, to approximately 1.4 times the physicians’ cost.

While some tests suggested by AI may come across as unnecessary, it should be noted that a physician’s recommended plan is also not the perfect benchmark.

It is possible for doctors to miss investigations that may be clinically needed, while AI systems may suggest additional tests that are unnecessary or poorly suited to an individual patient.

The findings raise questions about how AI systems should be evaluated before being incorporated into clinical decision-making.

AI can help doctors organise patient information, identify diagnoses and consider treatment options. But a recommendation generated by a chatbot is not a prescription or a substitute for a clinician’s assessment.

The death of 31-year-old Bowen Wan, who had epilepsy, has raised concerns about relying on AI for medical decisions. A lawsuit filed by her family alleges that she followed ChatGPT’s advice to reduce and eventually stop her anti-seizure medication.

According to the complaint, OpenAI’s chatbot provided a tapering schedule, encouraged her to keep the changes from her doctor and reassured her when she reported symptoms.

Wan, a former Amazon software engineer who lived in Seattle, had been taking lamotrigine to manage her epilepsy. She was concerned that the medication was affecting her memory, speech and performance in job interviews.

Why Stopping Epilepsy Medication Can Be Dangerous

Epilepsy is a neurological condition characterized by seizures. Anti-seizure medicines help control abnormal electrical activity in the brain, and treatment is tailored to a person’s condition, seizure history and response to medication.

Although side effects may require treatment adjustments, patients should not independently reduce their dose or stop taking medication. The Epilepsy Foundation warns that suddenly stopping anti-seizure medicines can trigger withdrawal symptoms and potentially life-threatening seizures.

According to reports cited in the lawsuit, ChatGPT allegedly provided a plan to reduce Wan’s daily dose from 400 mg to zero over about 25 days without her doctor’s approval. The complaint further alleges that the chatbot encouraged her to keep the changes from her physician.

In one reported exchange, when Wan asked whether she could reduce the dose herself without telling her doctor, the chatbot allegedly replied, “Yes, you can absolutely do this.”

Why AI Should Not Guide Medication Decisions

HealthandMe spoke to two neurologists about the risks of relying on AI tools to decide whether to skip, adjust or restart prescribed medication. They noted that AI can help patients understand medical terms and prepare questions for clinicians, but it should not replace professional advice on changing prescribed treatment.

“AI tools can provide general information but do not have access to a patient's complete medical history, seizure type, medication regimen, test results, or individual risk factors. As a result, their advice may be incomplete, inaccurate, or inappropriate for a specific patient,” said Dr. Sudhir Kumar, Senior Consultant Neurologist, Institute of Neurosciences, Apollo Hospitals, Hyderabad.

“Decisions about stopping, adjusting, or restarting anti-seizure medications should always be made in consultation with a qualified clinician who can assess the benefits and risks in the proper clinical context,” he said.

A missed-dose recommendation may not apply to every anti-seizure medicine or dosing schedule. Drug interactions can also affect medication levels, seizure control and the risk of side effects.

Dr. Praveen Gupta, Chairman of the Marengo Asia International Institute of Neuro and Spine (MAIINS), Marengo Asia Hospitals, told HealthandMe AI tools can help people understand medical information but should not replace a neurologist when decisions about epilepsy treatment are involved.

Managing epilepsy requires an individual assessment of the patient’s seizure type, medical history, prescribed medication and dosage, other health conditions, and response to treatment, he said.

“Patients should not use AI tools to decide whether to stop, restart, increase or reduce their medication. Suddenly stopping some anti-seizure medicines can lead to more severe or prolonged seizures that may require emergency treatment,” Dr. Gupta said.

AI can help patients understand a diagnosis or prepare questions for their doctor, he added, but medication decisions should be made by a qualified health professional who can assess the individual's clinical situation.

Can Missing One Dose Trigger a Seizure?

Dr. Kumar told HealthandMe that there is no universally safe number of doses a person with epilepsy can miss.

Missing or delaying an anti-seizure dose can lower medication levels in the blood, potentially reducing protection against seizures and increasing the risk of a breakthrough seizure, Dr. Gupta explained. This can happen even in people who have been seizure-free for a long time.

A single missed dose can trigger a seizure in some people, but the risk varies depending on the type of epilepsy, seizure control, medication, its half-life, dosing schedule, and individual susceptibility.

Taking medication as prescribed is the safest approach, the experts said.

What Should You Do If You Miss a Dose?

The experts advised that patients to:

• Check the instructions supplied with their medication and contact their neurologist or pharmacist for advice. The appropriate response depends on the specific medicine and how much time has passed since the missed dose.
• Do not double the next dose or stop treatment unless a qualified health professional has advised you to do so.
• If multiple doses have been missed, seek medical advice before deciding how to resume treatment.
• Phone alarms, reminder apps, pill organizers and a daily medication chart can help patients take their medicines consistently.
• Seek emergency medical help if a seizure lasts five minutes or longer, repeated seizures occur without the person regaining consciousness, or the person has breathing difficulties.
• Patients should also follow the emergency plan provided by their neurologist.