What to do with a head injury

Yes, you should watch anyone who has had a head injury for the signs of concussion. Sometimes you may not see the signs immediately. Call 999 if you suspect they have concussion.

Back to questions

Are there any other reasons I might need to call 999 after a head injury?

 Call 999 if:   

• They become less responsive or unresponsive  
• They have numbness or weakness in any part of their body  
• They have clear fluid or blood coming from their ears or nose  
• They have a seizure  
• They have been in a serious accident or had a severe blow to the head  
  

They should also seek medical advice if:  

• They are over 65  
• They have had a previous brain injury  
• They are taking medicines to thin their blood  
• They have been drinking alcohol or taking drugs  
• There is no one to look after them  

You should also seek medical advice if you are unsure how bad the injury is but think it could be serious.

Head injury is a common reason for an emergency room visit. A large number of people who suffer head injuries are children. Traumatic brain injury (TBI) accounts for over 1 in 6 injury-related hospital admissions each year.

Causes

Common causes of head injury include:

• Accidents at home, work, outdoors, or while playing sports
• Falls
• Physical assault
• Traffic accidents

Most of these injuries are minor because the skull protects the brain. Some injuries are severe enough to require a stay in the hospital.

Symptoms

Head injuries may cause bleeding in the brain tissue and the layers that surround the brain (subarachnoid hemorrhage, subdural hematoma, epidural hematoma).

Symptoms of a head injury can occur right away or may develop slowly over several hours or days. Even if the skull is not fractured, the brain can hit the inside of the skull and be bruised. The head may look fine, but problems could result from bleeding or swelling inside the skull.

The spinal cord is also likely to be injured from falls from a significant height or ejection from a vehicle.

Some head injuries cause changes in brain function. This is called a traumatic brain injury. Concussion is a traumatic brain injury. Symptoms of a concussion can range from mild to severe.

First Aid

Learning to recognize a serious head injury and give basic first aid can save someone's life. For a moderate to severe head injury, CALL 911 OR THE LOCAL EMERGENCY NUMBER RIGHT AWAY.

Get medical help right away if the person:

• Becomes very sleepy
• Behaves abnormally, or has speech that does not make sense
• Develops a severe headache or stiff neck
• Has a seizure
• Has pupils (the dark central part of the eye) of unequal sizes
• Is unable to move all or part of an arm or leg
• Loses consciousness, even briefly
• Vomits more than once



Then take the following steps:

1. Check the person's airway, breathing, and circulation. If necessary, begin rescue breathing and CPR.
2. If the person's breathing and heart rate are normal, but the person is unconscious, treat as if there is a spinal injury. Stabilize the head and neck by placing your hands on both sides of the person's head. Keep the head in line with the spine and prevent movement. Wait for medical help.
3. Stop any bleeding by firmly pressing a clean cloth on the wound, unless you suspect a skull fracture. If the injury is serious, be careful not to move the person's head. If blood soaks through the cloth, do not remove it. Place another cloth over the first one.
4. If you suspect a skull fracture, do not apply direct pressure to the bleeding site, and do not remove any debris from the wound. Cover the wound with sterile gauze dressing.
5. If the person is vomiting or about to vomit, to prevent choking, roll the person's head, neck, and body as one unit while stabilizing the head and neck onto their side. This still protects the spine, which you must always assume is injured in the case of a head injury. Children often vomit once after a head injury. This may not be a problem, but contact a doctor for further guidance.
6. Apply ice packs to swollen areas (cover ice in a towel so it does not directly touch the skin).

DO NOT

Follow these precautions:

• DO NOT wash a head wound that is deep or bleeding a lot.
• DO NOT remove any object sticking out of a wound.
• DO NOT move the person unless absolutely necessary.
• DO NOT shake the person if they seem dazed.
• DO NOT remove a helmet if you suspect a serious head injury.
• DO NOT pick up a fallen child with any sign of head injury.
• DO NOT drink alcohol within 48 hours of a serious head injury.

A serious head injury that involves bleeding or brain damage must be treated in a hospital.

For a mild head injury, no treatment may be needed. However, call for medical advice and watch for symptoms of a head injury, which can show up later.

Your physician or health care provider will explain what to expect, how to manage any headaches, how to treat your other symptoms, when to return to sports, school, work, and other activities, and signs or symptoms to worry about.

• Children will need to be watched and make activity changes.
• Adults also need close observation and activity changes.

Both adults and children must follow the doctor or the provider's instructions about when it will be possible to return to sports.

When to Contact a Medical Professional

Call 911 or the local emergency number right away if:

• There is severe head or face bleeding.
• The person is confused, tired, or unconscious.
• The person stops breathing.
• You suspect a serious head or neck injury, or the person develops any signs or symptoms of a serious head injury.

Prevention

Not all head injuries can be prevented. The following simple steps can help keep you and your child safe:

• Always use safety equipment during activities that could cause a head injury. These include seat belts, bicycle or motorcycle helmets, and hard hats.
• Learn and follow bicycle safety recommendations.
• Do not drink and drive, and do not allow yourself to be driven by someone who you know or suspect has been drinking alcohol or is impaired in another way.



Alternative Names

Brain injury; Head trauma; Concussion - head injury; Traumatic - head injury

Patient Instructions

• Concussion in adults - discharge
• Concussion in adults - what to ask your doctor
• Concussion in children - discharge
• Concussion in children - what to ask your doctor
• Preventing head injuries in children

Images

• 
  Concussion
• 
  Bicycle helmet - proper usage
• 
  Head injury
• 
  Intracerebellar hemorrhage - CT scan
• 
  Indications of head injury

References

Hockenberry B, Pusateri M, McGrew C. Sports-related head injuries. In: Kellerman RD, Rakel DP, eds. Conn's Current Therapy 2022. Philadelphia, PA: Elsevier; 2022:790-794.

Hudgins E, Grady S. Initial resuscitation, prehospital care, and emergency room care in traumatic brain injury. In: Winn HR, ed. Youmans and Winn Neurological Surgery. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 348.

Papa L, Goldberg SA. Head trauma. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 34.

Review Date 11/13/2021

Updated by: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

How do you treat a head injury at home?

Be guided by your doctor, but self-care suggestions include:.

Don't drive home from the hospital. ... .

Rest quietly for the day..

Use icepacks over any swollen or painful area..

Take simple painkillers such as paracetamol for any headache. ... .

Arrange for someone to stay with you for the next 24 hours, in case you need help..

How do I know if my head injury is serious?

Danger signs in adults.

Have a headache that gets worse and does not go away..

Experience weakness, numbness, decreased coordination, convulsions, or seizures..

Vomit repeatedly..

Have slurred speech or unusual behavior..

Have one pupil (the black part in the middle of the eye) larger than the other..

What should you not do after a head injury?

Avoid activities that are physically demanding (e.g., heavy houscleaning, weightlifting/working-out) or require a lot of concentration (e.g., balancing your checkbook). They can make your symptoms worse and slow your recovery.

How long should I worry after a head injury?

See a provider within 1 to 2 days of a significant head injury with ongoing symptoms, even if emergency care isn't required. Seek emergency medical attention if your child experiences: Unconsciousness, confusion or disorientation after a head injury.