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Topic Overview

Head injury

Most injuries to the head are
minor. Bumps, cuts, and scrapes on the head and face usually heal well and can
be treated the same as injuries to other parts of the body. Minor cuts on the
head often bleed heavily because the face and scalp have many blood vessels
close to the surface of the skin. Often the injury is not severe, and you can stop the bleeding with home treatment.

Many head injuries can be prevented. Use
seat belts and helmets, and make your home safe to prevent falls.

Common causes of serious head injuries in adults include:

  • Car crashes. Almost half of all head injuries
    occur during a car crash. Teens and young adults are more likely to be hurt in
    car crashes than other age groups.
  • Falls, which are more likely to
    involve children younger than age 5 and adults older than age
    60.
  • Sports-related injuries and work-related accidents. Men have
    about twice as many head injuries as women. Sports-related injuries are very
    common but are not always reported.
  • Assaults and violent attacks.
    Gunshot wounds are the leading cause of death from a head injury.

Head injuries that involve force are more likely to cause a
serious injury to the brain. A
high-energy injury to the head increases the
likelihood of a serious injury even more. Be sure to evaluate the
person for signs and symptoms of a head injury after a fall or other type of
head injury.

It is sometimes hard to tell the difference
between a
concussion and a more serious
head injury. A person with a concussion may appear
dazed, stare blankly, or cry for no apparent reason. Nausea, vomiting,
headache, or dizziness may be present. A visit to a doctor is needed anytime
mild symptoms persist. Even if a visit to a doctor is not needed, watch anyone
who has had a head injury carefully for at least 24 hours to see whether signs
of a serious head injury develop.

Occasionally, after a head injury
you may feel as if you are not functioning as well as you did before the injury
(postconcussive syndrome). You may have blurred vision,
headache, nausea, vomiting, forgetfulness, or trouble concentrating. Some
people have problems with balance and coordination and personality changes.
These changes may be related to stress from the events around the accident
that caused the injury or from the injury itself. Many people have symptoms for
as long as 3 months after a head injury, and some even have problems for as
long as a year afterward.

When a head injury has occurred, look
for other injuries to other parts of the body that also may need attention.
Trouble breathing, shock, spinal injuries, and severe bleeding are all
life-threatening injuries that may occur along with a head injury and require
immediate medical attention.
Injuries to the spine, especially the neck, must be
considered when there has been a head injury. Be sure to check for other injuries to the face, mouth, or teeth whenever there is a head injury.

Check your
symptoms
to decide if and when you should see a doctor.

Check Your Symptoms

Have you had a head injury?
Yes
Head injury
No
Head injury
How old are you?
Less than 4 years
Less than 4 years
4 years or older
4 years or older
Are you male or female?
Male
Male
Female
Female
Is the wound bleeding?
If you think the wound may need stitches, it’s best to get them within 8 hours of the injury.
Yes
Bleeding wound
No
Bleeding wound
Would you describe the bleeding as severe, moderate, or mild?
Severe
Severe bleeding
Moderate
Moderate bleeding
Mild
Mild bleeding
Do you have symptoms of shock?
Yes
Symptoms of shock
No
Symptoms of shock
Do you think there could be a spinal cord injury?
Yes
Possible spinal cord injury
No
Possible spinal cord injury
These could appear at the time of the injury or later.
Yes
Symptoms of serious head injury
No
Symptoms of serious head injury
Did a seizure occur after the head injury?
Yes
Seizure after head injury
No
Seizure after head injury
Did the seizure occur within the past 2 days (48 hours)?
Yes
Seizure occurred within past 2 days
No
Seizure occurred within past 2 days
Is there a wound that goes through the skull, such as a knife or gunshot wound?
Yes
Penetrating wound
No
Penetrating wound
Yes
Symptoms of skull fracture
No
Symptoms of skull fracture
Is there swelling anywhere on the head?
Swelling in certain areas of the head can be a sign of a skull fracture.
Yes
Swelling on head
No
Swelling on head
Is the only swelling a bump or “goose egg” on the forehead?
Swelling in any other area of the head, such as the temple area or the side or back of the head, could be more serious.
Yes
Only swelling is bump or goose egg on forehead
No
Only swelling is bump or goose egg on forehead
Did you pass out (lose consciousness) after the injury?
Yes
Lost consciousness after injury
No
Lost consciousness after injury
When did you pass out?
Within the past 24 hours
Loss of consciousness within past 24 hours
More than 24 hours ago
Loss of consciousness more than 24 hours ago
Was there a lot of force involved in the head injury?
Some examples are a fall onto the head from more than a few feet, or a very hard blow to the head, such as in a car crash or a forceful sports injury.
Yes
A lot of force involved in head injury
No
A lot of force involved in head injury
When did the head injury occur?
Less than 24 hours ago
Injury occurred less than 24 hours ago
From 1 full day (24 hours) to 1 week ago
Injury occurred from 1 day to 1 week ago
More than 1 week ago
Injury occurred more than 1 week ago
Are you under the influence of drugs or alcohol right now?
Yes
Currently under the influence of alcohol or drugs
No
Currently under the influence of alcohol or drugs
Have you vomited more than once since the injury?
Yes
Vomited more than once after injury
No
Vomited more than once after injury
Do you think that the injury may have been caused by abuse?
Yes
Injury may have been caused by abuse
No
Injury may have been caused by abuse
Have you had any memory loss after the injury?
Yes
Memory loss after injury
No
Memory loss after injury
Have you been getting headaches?
Yes
Headaches
No
Headaches
Have the headaches been:
Getting worse?
Headaches are getting worse
Staying about the same (not better or worse)?
Headaches are unchanged
Getting better?
Headaches are getting better
Some symptoms may appear days or even more than a week after a head injury.
Yes
Other symptoms after head injury
No
Other symptoms after head injury
Are the symptoms:
Getting worse?
Symptoms are getting worse
Staying about the same (not better or worse)?
Symptoms are unchanged
Getting better?
Symptoms are improving
Have you had symptoms for more than 2 weeks after the injury?
Yes
Symptoms for more than 2 weeks after injury
No
Symptoms for more than 2 weeks after injury

Many things can affect how your body responds to a symptom and what kind
of care you may need. These include:

  • Your age. Babies and older
    adults tend to get sicker quicker.
  • Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart
    disease, you may need to pay closer attention to certain symptoms and seek care
    sooner.
  • Medicines you take. Certain
    medicines, herbal remedies, and supplements can cause symptoms or make them
    worse.
  • Recent health events, such as surgery
    or injury. These kinds of events can cause symptoms afterwards or make them
    more serious.
  • Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug
    use, sexual history, and travel.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be
able to take care of this problem at home.

  • Try home treatment to relieve the
    symptoms.
  • Call your doctor if symptoms get worse or you have any
    concerns (for example, if symptoms are not getting better as you would expect).
    You may need care sooner.

Shock is a life-threatening condition that may quickly occur
after a sudden illness or injury.

Symptoms of shock (most of which will be present) include:

  • Passing out (losing consciousness).
  • Feeling very dizzy or
    lightheaded, like you may pass out.
  • Feeling very weak or having
    trouble standing.
  • Not feeling alert or able to think clearly. You
    may be confused, restless, fearful, or unable to respond to questions.

Other symptoms related to a head injury that may appear later include:

  • Repeated episodes of feeling dizzy or
    lightheaded.
  • Changes in mood or personality. For a baby or toddler,
    you may notice this as the child being a lot fussier than
    normal.
  • Changes in the ability to concentrate and listen.
  • Ringing in the ears.

Symptoms of a spinal cord injury in an
adult or older child may include:

  • Severe neck or back pain.
  • Not being
    able to move a part of the body. (This is not the same as being unable to move
    because of pain or because of a direct injury to that
    area.)
  • Weakness, tingling, or numbness in the arms or
    legs.
  • New loss of bowel or bladder control.

Symptoms of a serious head injury may
include:

  • Passing
    out.
  • Confusion.
  • Extreme
    sleepiness.
  • Unsteady walking.
  • Slurred
    speech.
  • A difference in the size of the pupils of the
    eyes.
  • New vision problems.

With severe bleeding, any of these may
be true:

  • Blood is pumping from the wound.
  • The
    bleeding does not stop or slow down with pressure.
  • Blood is quickly soaking through bandage after bandage.

With moderate bleeding, any of these may
be true:

  • The bleeding slows or stops with pressure but
    starts again if you remove the pressure.
  • The blood may soak through
    a few bandages, but it is not fast or out of control.

With mild bleeding, any of these may be
true:

  • The bleeding stops on its own or with
    pressure.
  • The bleeding stops or slows to an ooze or trickle after
    15 minutes of pressure. It may ooze or trickle for up to 45 minutes.

Symptoms of a skull fracture may
include:

  • Clear or bloody fluid draining from the ears or
    nose.
  • Bruising under the eyes or behind the
    ears.
  • Drooping of the face.
  • A dent anywhere on the head.

Call 911 Now

Based on your answers, you need
emergency care.

Call 911 or other emergency services now.

Seek Care Today

Based on your answers, you may need care soon. The
problem probably will not get better without medical care.

  • Call your doctor today to discuss the symptoms
    and arrange for care.
  • If you cannot reach your doctor or you don’t
    have one, seek care today.
  • If it is evening, watch the symptoms and
    seek care in the morning.
  • If the symptoms get worse, seek care
    sooner.

Make an Appointment

Based on your answers, the problem may not improve without medical
care.

  • Make an appointment to see your doctor in the
    next 1 to 2 weeks.
  • If appropriate, try home treatment while you
    are waiting for the appointment.
  • If symptoms get worse or you have
    any concerns, call your doctor. You may need care sooner.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

  • Call your doctor now to discuss the symptoms and
    arrange for care.
  • If you cannot reach your doctor or you don’t have
    one, seek care in the next hour.
  • You do not need to call an
    ambulance unless:

    • You cannot travel safely either by driving
      yourself or by having someone else drive you.
    • You are in an area
      where heavy traffic or other problems may slow you down.

Call 911 Now

Based on your answers, you need
emergency care.

Call 911 or other emergency services now.

Do not move the person unless there is an immediate threat to the person’s life, such as
a fire. If you have to move the person, keep the head and neck supported and in
a straight line at all times. If the person has had a diving accident and is
still in the water, float the person face up in the water.

Call 911 Now

Based on your answers, you need
emergency care.

Call 911 or other emergency services now.

Put direct, steady pressure on the
wound until help arrives. Keep the area raised if you can.

Head Injury, Age 3 and Younger

Home Treatment

Home treatment for a head injury is
only appropriate if there was no
loss of consciousness or inability to recall current
events (amnesia) after the injury. If either loss of
consciousness or amnesia has occurred, check your
symptoms
to determine when to see your doctor.

Immediately after a head injury:

  • Check for:
    • Seizure.
    • Confusion or not acting normal.
      Ask the person his or her name, address, age, the date, location, and the name
      of the president.
    • Severe irritability or wanting to
      fight.
    • Inability to remember what happened just before or after the
      injury.
    • Trouble speaking or slurred
      speech.
    • Dizziness, lightheadedness, or unsteadiness that makes it
      hard to stand or walk.
    • Symptoms that affect one side of the body
      more than the other side, such as numbness, weakness, or trouble
      moving.
    • Loss of vision.
    • Vomiting.
    • A severe headache.
    • Abnormally deep sleep, trouble waking up, or extreme
      sleepiness.
  • To stop any bleeding, apply firm pressure
    directly over the wound with a clean cloth or bandage for 15 minutes. If the cut is deep and may have penetrated the skull,
    emergency treatment is needed.
  • Check for injuries to other parts of
    the body, especially if the person has fallen. The alarm of seeing a head
    injury may cause you to overlook other injuries that need
    attention.
  • Apply
    ice or cold packs to reduce the swelling. A “goose egg” lump may appear
    anyway, but ice will help ease the pain.
  • Be sure to follow any home
    care instructions from your doctor. If you have questions about the
    instructions, call your doctor.

Minor head injuries

Many minor head injuries that do
not involve loss of consciousness or amnesia may be treated at home. A person
who has had a head injury should be watched for any problems
from the injury. Home treatment can also help relieve swelling and bruising of the
skin or scalp and pain caused by a minor head injury.

If a visit to your doctor is not needed immediately:

  • Apply
    ice or cold packs to reduce the swelling. A “goose egg” lump may appear
    anyway, but ice will help ease the pain.
  • You may use
    acetaminophen, such as Tylenol, to relieve
    a mild headache or pain from the injury.

Watch

  • The injured person should be watched by a
    responsible adult for the next 24 hours.

    • Call 911 or go to an emergency room immediately if
      unconsciousness or
      seizure activity develops.
    • Seek medical
      care if any new symptoms, such as vomiting, a severe headache, blurred or
      double vision, or unsteadiness, develop after the injury.

Rest

  • Rest is the best treatment for a
    concussion. Get plenty of sleep at night, and take
    rests during the day.
  • If a mild to moderate
    headache develops, lie down and try to relax your
    entire body.
  • Take only
    acetaminophen, such as Tylenol, to relieve
    a mild headache or pain from the injury. Do not use other nonprescription or
    prescription medicines for pain without approval from your
    doctor.
  • Do not drink alcohol or use illegal drugs. Alcohol and
    illegal drugs can slow your recovery and increase your risk of a second head
    injury.

If vomiting occurs:

  • Wait 1 hour after the last episode of vomiting
    before taking liquid.

    • After an hour, drink
      4 fl oz (125 mL) of clear
      liquid every 20 minutes for 1 hour.
    • As you feel
      better, begin to eat small amounts of clear soups, mild foods, and
      liquids.
  • Keep eating clear soups, mild foods, and liquids
    until all symptoms are gone for 12 to 48 hours. Gelatin dessert, dry toast,
    crackers, and cooked cereal are good choices.

Recovery

  • Return to your normal activities gradually.
    Don’t try to do too much at once.
  • Avoid activities that could lead
    to another head injury. If your head injury occurred during a sporting event,
    you should be evaluated for a concussion and cleared by a doctor before
    returning to play.
  • Ask your doctor when
    it will be safe for you to drive a car or operate equipment, if that is a
    concern.
  • Take only
    acetaminophen, such as Tylenol, to relieve
    a mild headache or pain from the injury. Do not use other nonprescription or
    prescription medicines for pain unless your doctor tells you to.
  • Do
    not use alcohol until your doctor tells you that you are well enough to do so.
    Alcohol and illegal drugs can slow your recovery and increase your risk of a
    second head injury.

Symptoms to watch for during home treatment

Call your doctor if any of the following occur during home
treatment:

  • Bleeding increases.
  • Other symptoms, such
    as confusion, speech or vision problems, vomiting, or headache develop.
  • Symptoms become more severe or more
    frequent.

Prevention

Prevent injuries

  • Wear your seat belt when in a motor vehicle. Use
    child car seats.
  • Help your child prevent injury during sports and other activities.
  • Do not use alcohol or
    other drugs before participating in sports or when operating a motor vehicle or
    other equipment.
  • Wear a helmet and other protective clothing
    whenever you are biking, motorcycling, skating, skateboarding, kayaking,
    horseback riding, skiing, snowboarding, or rock climbing.
  • Wear a
    hard hat if you work in an industrial area.
  • Do not dive into
    shallow or unfamiliar water.
  • Prevent falls in your home by removing hazards that might cause a fall.
  • Do not
    keep guns in your home. If you must keep guns, lock them up and store them
    unloaded. Lock ammunition in a separate area.

Preparing For Your Appointment

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Questions to prepare for your appointment

You can help your
doctor diagnose and treat your condition by being prepared to answer the
following questions:

  • When and how did the injury occur?
  • Do
    you remember all the details before, during, and after the injury? If you do
    not remember, are there witnesses available who can tell you about the
    injury?
  • How did you act after the head injury?
  • Did you
    lose consciousness? If yes, for how long?
  • What are your main
    symptoms? How long have you had symptoms?
  • Have you ever had a
    concussion (traumatic brain injury) in the past?

    • How long ago?
    • How severe was
      it?
    • How was it treated?
    • Do you continue to have
      problems because of this injury?
  • Was this injury intentionally caused by another
    person?
  • What object caused the injury? Was there or is there an
    object in a cut on the head?
  • What home treatment measures have you
    used to treat the head injury? Did they help?
  • What prescription or
    nonprescription medicines do you use?
  • If a cut or scrape occurred,
    is your tetanus immunization up-to-date?
  • Were alcohol or drugs
    involved in the injury?
  • Do you have any
    health risks?

Related Information

Credits

ByHealthwise Staff
Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP – Emergency Medicine
Adam Husney, MD – Family Medicine
Kathleen Romito, MD – Family Medicine
Specialist Medical Reviewer Kathleen Romito, MD – Family Medicine

Current as ofMarch 20, 2017