Hello, Painful headache with nosebleeds are commonly caused by medical conditions like hypertension, overuse of drugs(cocaine), head injury, carbon monoxide poisoning, deviated nasal septum, sinus infections, heart disease, leukemia, etc. It can also occur due to dry environment, allergies, use of excessive decongestants or sprays, cold, etc. Since he has low heart beats & has history of blackouts, he is suggested to get clinically examined by a GP or a Cardiologist. Get all the required blood & Imaging tests done to detect the pathology causing the discomfort. It is better to rule out any developing CAD (coronary artery disease) or a DNS (deviated nasal septum). His treatment (by medicine or surgery) will depend on the severity of the pathology detected. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. Nupur K, General & Family Physician