Ice Application to Forehead for Epistaxis
Applying ice to the forehead is NOT effective for controlling epistaxis and should not be recommended as a first aid measure. 1
Evidence Against Ice Application to Forehead
The most recent and authoritative guidelines explicitly address this practice:
The 2024 American Heart Association and American Red Cross guidelines state that "the usefulness of cryotherapy (ice) for managing epistaxis in the first aid setting is unknown." 1 This represents a Class 2b recommendation with limited data, meaning there is insufficient evidence to support its use.
The 2021 ILCOR systematic review found no studies that directly evaluated ice application in patients with actual epistaxis—only indirect studies in healthy adults without nosebleeds. 1
When ice packs were applied to the forehead specifically, they were significantly less effective than intraoral ice packs (5% reduction in nasal blood flow versus 23% reduction; P<0.05). 1
Multiple observational studies showed no significant change in nasal blood flow, nasal blood volume, or nasal cavity measurements when cold compresses were applied to the forehead or neck. 1
What Actually Works: Evidence-Based First Aid
The only intervention required in the vast majority of epistaxis cases is nasal compression alone. 1
Correct First-Line Management
Position the patient sitting upright with head tilted slightly forward to prevent blood from entering the airway or stomach. 1, 2, 3
Apply firm, continuous pressure to the soft lower third of the nose for a full 10-15 minutes without checking if bleeding has stopped. 1, 2, 3 This resolves 90-95% of anterior epistaxis cases. 4
Instruct the patient to breathe through their mouth and spit out blood rather than swallowing it. 1, 2, 3
If Compression Alone Fails
Apply topical vasoconstrictors (oxymetazoline or phenylephrine) after clearing clots, which stops 65-75% of emergency department epistaxis cases. 5, 2, 6
Resume firm compression for another 5-10 minutes after applying the vasoconstrictor. 2
Common Pitfalls to Avoid
Insufficient compression time: Many providers and patients check for bleeding cessation before the full 10-15 minutes, which prevents adequate clot formation. 2, 4
Incorrect head position: Tilting the head backward (a common misconception) allows blood to flow into the airway or stomach, potentially causing aspiration or vomiting. 1 Only 66% of healthcare providers in one study knew the correct head position. 4
Wrong compression site: Only 30% of healthcare providers in one study could identify the correct site for nasal compression (soft lower third of nose). 4
Applying ice to the forehead based on outdated folk wisdom: This practice persists despite lack of evidence and may delay effective treatment. 1
When to Seek Medical Attention
Bleeding persists after 15 minutes of continuous proper compression. 1, 3
Patient experiences dizziness, hemodynamic instability, or signs of significant blood loss. 1, 5
Patient is taking anticoagulants or antiplatelet medications and bleeding has not stopped. 1
Epistaxis due to trauma with signs of brain injury, nasal deformity, or facial fracture. 1