Head Injury

A head injury can range from a minor bump to a life-threatening condition affecting your brain. Most head injuries are mild and temporary, but some can cause serious complications like bleeding inside the skull or permanent brain damage.

Table of contents

• What is a head injury?
• Types of head injuries
• What causes head injuries?
• Symptoms and warning signs
• Possible complications
• How head injuries are diagnosed
• Treatment approaches
• Recovery and what to expect
• Preventing head injuries

What is a head injury?

A head injury is any damage to your head, including your skull, scalp, and brain^[1]. When someone experiences a head injury, it means they were hit in the head hard enough to potentially affect how the brain works^[3].

The skull is hard and protects the brain, which is a soft organ. When you receive a knock to the head, the brain can move around inside the skull and hit against the skull and facial bones. This movement can cause the brain to swell and even bleed^[14].

Most head injuries are minor and temporary issues^[1]. However, it can be hard to assess how serious a head injury is just by looking at it. Some minor head injuries bleed a lot, while some major injuries don’t bleed at all^[2].

Types of head injuries

Healthcare providers classify head injuries into two main groups^[1]:

Closed head injuries are injuries that don’t break through your skull. Most head injuries are closed. An outside force strong enough to move the brain within the skull causes these injuries. Common causes include falls, motor vehicle crashes, sports injuries, and being struck by an object^[3].

Open head injuries (also called penetrating injuries) occur when something pierces through your skull into your brain. It usually takes severe trauma to cause an open head injury. Examples include injuries from bullets, shrapnel, or bone fragments^[1][3].

Head injuries can also be classified by their severity as mild, moderate, or severe^[11]. More than 75% of all head injuries are mild^[11].

Some specific types of head injuries include^[1]:

• Concussions – the most common type of head injury, where the brain has been shaken but shows no evidence of structural damage^[15]
• Skull fractures – breaks in the skull bone
• Scalp wounds – cuts or injuries to the scalp
• Traumatic brain injuries – injuries that affect how the brain functions
• Hematoma – a collection or clotting of blood outside blood vessels in the brain^[2]
• Hemorrhage – uncontrolled bleeding in the space around the brain or within brain tissue^[2]

What causes head injuries?

Any strong force or impact can cause a head injury^[1]. Head injuries can be divided into two categories: those caused by blows to the head and those caused by shaking^[2].

Head injuries caused by shaking are most common in infants and small children, but they can occur any time someone experiences violent shaking^[2].

Head injuries caused by a blow to the head are usually associated with^[2]:

• Motor vehicle accidents
• Falls
• Physical assaults
• Sports-related accidents

In 2020, more than 214,000 people in the United States needed in-patient care for a head injury, and more than 69,000 people died from issues involving traumatic brain injury^[11].

Symptoms and warning signs

Head injury symptoms can vary depending on the type and what caused it. Mild head injuries may only hurt in one spot for a few minutes^[1]. Many head injuries don’t cause symptoms right away, especially closed head injuries. It can take hours, days, or even weeks to start noticing signs or symptoms^[1].

Common symptoms of head injuries include^[1][3]:

• Headaches
• Swelling or a raised bump
• Bruising
• Bleeding from the scalp, nose, or ears
• A stiff neck
• Clear fluid leaking from ears or nose
• Dizziness
• Nausea and vomiting
• Mental symptoms like trouble concentrating, memory issues, or feeling like you’re in a fog
• Changes in eyes or vision, including dilated pupils or blurry vision
• Losing consciousness (passing out or fainting)
• Seizures
• Confusion or disorientation

For mild head injuries, symptoms usually get better on their own within a few weeks. Common symptoms during recovery include feeling tired, problems sleeping, poor concentration, dizziness, poor balance, sensitivity to light and sound, ringing in the ears, headaches with nausea, irritability, mood swings, and feeling sad^[22].

When to seek urgent medical care

Call emergency services (911 or triple zero) immediately if someone has a head injury and experiences any of these symptoms^[1][6][14]:

• Loss of consciousness, even briefly
• Seizures or convulsions
• Blood or fluid coming from the nose or ears
• Bruising around the eyes or ears
• The worst headache ever experienced
• Repeated vomiting or nausea (three or more times)
• Confusion that gets worse
• Difficulty waking up or staying awake
• Unequal eye pupil size
• Slurred speech or trouble speaking
• Sudden weakness on one side of the body
• Loss of vision, blurry vision, or double vision

Possible complications

Bleeding inside the skull is a potentially severe complication of a head injury. If blood builds up inside the skull, it can put extra pressure on the brain and damage it^[1]. This is called a subdural hematoma – when blood collects on the surface of the brain, under the skull^[2].

Head injuries may also cause intracranial hemorrhage, a type of stroke^[1]. These complications can cause short-term or permanent damage to the brain.

Some people with mild head injuries have short-term memory loss and may not remember the hit or injury that caused the damage. More severe head injuries can permanently affect brain function. People might experience permanent memory issues, mental health conditions, or lose some ability to move or use parts of their body^[1].

Head injuries can be fatal if they damage the brain’s ability to control the heart, lungs, or other vital systems^[1].

As many as 30% of patients who experience a concussion develop post-concussive syndrome. This condition consists of a persistence of any combination of the following symptoms after a head injury: headache, nausea, vomiting, memory loss, dizziness, double vision, blurred vision, emotional changes, or sleep disturbances. Post-concussive syndrome usually lasts 2 to 4 months, with symptoms typically peaking 4 to 6 weeks following the injury. In some cases, symptoms can last for a year or longer^[15].

How head injuries are diagnosed

Anyone suspected of having a head injury should be assessed by a doctor^[14]. Healthcare providers use several methods to diagnose head injuries and determine their severity.

The Glasgow Coma Scale is a 15-point test that helps doctors assess the initial severity of a brain injury by checking a person’s ability to follow directions and move their eyes and limbs. The coherence of speech also provides important clues. Higher scores mean less severe injuries^[9].

Healthcare providers will ask important questions about the injury, such as how it occurred, whether the person lost consciousness and for how long, and what symptoms have appeared^[9].

Imaging tests are commonly used to diagnose head injuries^[9]:

Computerized tomography (CT) scan is usually the first test performed in an emergency room for a suspected traumatic brain injury. A CT scan uses a series of X-rays to create a detailed view of the brain. It can quickly show fractures, bleeding in the brain, blood clots, bruised brain tissue, and brain swelling^[9].

Magnetic resonance imaging (MRI) may be used to get more detailed images of the brain. An MRI uses magnets, radio waves, and a computer to image the body’s soft tissues^[9].

While in the emergency department at hospital, you can expect observation, mild painkillers for any headache, anti-nausea tablets, an X-ray of the neck if there’s neck pain, and a CT scan if needed. For a mild head injury, patients are typically discharged home with family or friends^[14].

Treatment approaches

Treatment for head injuries varies greatly based on the severity of the injury^[1]. Just as no two people are exactly alike, no two brain injuries are exactly alike. Brain injury requires access to a full range of treatment and community-based supports provided by appropriately educated healthcare professionals^[13].

Treatment for mild head injuries

Most head injuries are mild. There is no specific treatment for mild head injury other than plenty of rest and not overdoing things^[14]. Rest is one of the best things to help the brain recover, especially in the first 24 hours^[22].

Many patients with mild-to-moderate headaches, dizziness, and nausea are considered to have low-risk injuries and may require only minimal observation. These patients may be discharged if a reliable individual can monitor them. Patients should be given instruction sheets explaining that someone should check on the person every 2 hours^[15].

After one or two days of rest, it’s important to ease back into regular activities even if there are still some mild symptoms. If symptoms get worse, the person should cut back on that activity^[16].

Light physical activity, such as taking a short walk or doing light housework, or light exercise like walking, stationary bike, or swimming, should begin as soon as it feels okay^[22].

Treatment for moderate to severe head injuries

More serious head injuries may require hospital admission, surgery, or other intensive treatments. Treatment modalities vary extensively based on the severity of the injury and range from daily therapy sessions to surgery such as removal of blood clots or repair of skull fractures^[12].

Treatment can be acute (care in the hospital immediately after injury) or post-acute (long-term treatment for persisting side effects). The type of treatment depends on the severity of the injury, but everyone’s treatment should be individualized to their condition^[13].

Medications

For pain relief, take acetaminophen (such as Tylenol). Talk to your doctor about using products with aspirin or ibuprofen (such as Advil or Motrin), as they can increase the risk of bleeding^[22]. Ask your healthcare provider about medications that are safe to take during recovery to help with symptoms^[16].

Recovery and what to expect

It can take some time for the brain to recover from a head injury. During this time, headaches, dizziness, and mild thinking problems are common^[14]. Most people recover within 2 days from a mild injury^[6], and most children with a concussion feel better within 2 to 4 weeks^[4].

However, some children and adults have symptoms that affect their behavior, mood, memory, or emotions for months or longer. Symptoms that stay around can affect children as they grow up and even through adulthood^[4].

Recovery from a head injury means being able to do regular activities without experiencing symptoms. Recovery may be slower among older adults, young children, and people who have had a concussion or other head injury in the past^[16].

Self-care during recovery

Important self-care steps during recovery include^{[14][16][20][22]}:

• Get plenty of sleep at night and rest during the day
• Avoid physically demanding activities and activities requiring heavy concentration
• Eat healthy meals and snacks throughout the day – the brain needs energy to recover
• Limit screen time and loud music before bed
• Sleep in a dark room and keep to a fixed bedtime and wake-up schedule
• Stay connected to friends and loved ones and talk with them about how you are feeling
• Write down things that may be harder than usual to remember
• If easily distracted, try to do one thing at a time

Don’t drink alcoholic beverages or use other drugs (such as cannabis) until your healthcare provider says you are well enough. Alcohol and other drugs may slow recovery and put you at risk of further injury^[20][22].

Returning to activities

Don’t go to work or school, or resume sporting activity until you have fully recovered^[14]. Ask your healthcare provider for written instructions about when you can safely return to work, school, or other activities, such as driving a car^[16].

Because your ability to react may be slower after a head injury, ask your healthcare provider when you can safely drive a car, ride a bike, or operate heavy equipment^[20]. Do not drive if you have vision problems, slowed thinking, slowed reaction time, reduced attention, or poor judgment^[22].

Talk with your healthcare provider about when you can return to work. Consider talking with your employer about returning to work gradually and about changing work activities or schedule until you recover (for example, work half-days)^[20].

Stay away from activities that could cause another head injury (like contact sports) until the doctor says it’s okay. A second blow to the head can cause more damage to the brain^[22].

When to seek additional help

Talk to your healthcare provider if symptoms don’t go away. Some people will have symptoms for months or longer. If symptoms do not go away within 2 to 3 weeks or get worse after you return to your regular activities, contact your healthcare provider^[16].

If you develop any new symptoms or are concerned, you should also see your doctor^[6].

Preventing head injuries

There are several things you can do to help prevent head injuries^[4][6]:

• Wear a seat belt in the car
• Play sports safely and wear appropriate protective equipment
• Reduce your risk of falls by keeping floors clear, using handrails on stairs, and ensuring good lighting
• Avoid activities that can put you at risk for another injury to your head and brain while recovering from a head injury

Exposure to repeated head impacts increases the chance for concussions and other traumatic brain injuries, as well as the potential for changes in the brain and brain diseases. There’s a bigger risk of more serious and longer-lasting symptoms when someone has multiple concussions^[4].

It’s always better to go to the emergency room or see a healthcare provider if you’ve experienced a sports injury or trauma, just to be sure you don’t have a more serious injury than it seems^[1].