Health Library Head Injury, Age 4 and OlderFrom Healthwise

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. Superficial 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 the bleeding will stop with home treatment. For more information, see how to stop bleeding.

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:¹

• 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. It is important to evaluate the person for signs and symptoms of a head injury after a fall or other type of head injury.

It is sometimes difficult to tell the difference between a mild 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 surrounding 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. Difficulty 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.

Review the Emergencies and Check Your Symptoms sections to determine if and when you need to see a doctor.

• Breathing stops for longer than 15 seconds. Begin rescue breathing.
• Unconsciousness:
  • Occurs for longer than a few seconds after the injury.
  • Develops at any time after the injury.
• The head injury caused a deformity of the skull, such as a sunken spot (depression), bone fragments, or exposed brain (open head injury).
• An obvious wound penetrates the skull, such as a knife or gunshot wound (open head injury). Do not remove objects from the wound.
• A seizure occurs. Protect the person from injury during the seizure.
• Signs of shock are present.
• Severe bleeding does not slow during the first 15 minutes of direct pressure. See how to stop bleeding.
• Signs of a serious spinal injury are present, including:
  • Inability to move any part of the body (paralysis), and the inability to move is not caused by a direct injury to that part of the body or severe pain.
  • Severe pain in the neck or back.
  • Weakness, tingling, or numbness in the arms or legs.
  • Loss of bowel or bladder control.
• Signs of a serious head injury are present, such as:
  • Confusion or obvious abnormal behavior.
  • Difficulty waking up or sleepiness.
  • Difficulty speaking or slurred speech.
  • Symptoms that affect one side of the body more than the other side, such as numbness, weakness, or difficulty moving.
  • Changes in the size or shape of the pupils.
  • Loss of vision in one or both eyes.

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

	Yes	Have you had a head injury but you do not have signs of a serious head injury?
When to See a Doctor See significance of a head injury if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Did you have loss of consciousness for less than a few seconds? Yes Are you not sure whether you lost consciousness? Yes Are you not able to remember what happened before or just after the injury? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Is your scalp still bleeding after a head injury?
When to See a Doctor See significance of bleeding after a head injury if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: If you need a tetanus shot, call your doctor to arrange for the shot as soon as possible. Your need for a tetanus shot depends on the seriousness of your wound and your tetanus shot history. Your doctor may be able to tell you over the telephone if you need a tetanus shot. Note: Cuts that require treatment should be evaluated by a doctor within 8 hours. To decide whether a cut may need medical treatment, see the topic Cuts. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have moderate bleeding that has not stopped after 15 minutes of direct pressure? Yes Do you have mild bleeding from the scalp that has not stopped after applying direct pressure 3 times for 15 minutes each (45 minutes total)? Call your health professional today if you answer "Yes" to any of the following questions. Yes Were you cut by something clean and your last tetanus shot was longer than 10 years ago? Note: Something is clean if it does not have dirt, soil, spit, or feces on it. Examples include a broken water glass, a kitchen knife, or sewing scissors. Yes Were you cut by something dirty and your last tetanus shot was longer than 5 years ago? Note: Something is dirty if it has dirt, soil, spit, or feces on it. Examples include a garden tool, a dirty nail, or a piece of glass that has been buried in the dirt. Yes Are you not sure if you were cut by something clean or dirty and your last tetanus shot was longer than 5 years ago? Yes Are you not sure when you had your last tetanus shot? Yes Did you not get the first series of tetanus shots (primary vaccination series)? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have any signs of a skull fracture?
When to See a Doctor See significance of signs of a skull fracture if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have clear or bloody fluid draining from your ears or nose? Note: This clear or bloody drainage begins after a head injury and is not caused by a cut, direct blow to the nose, allergies, crying, or cold symptoms. Yes Do you have bruising or discoloration around both eyes or behind one ear? Yes Do you have a depression in or a deformity of the skull? Yes Do you have drooping or numbness on one side of your face (facial palsy)? Yes Do you think you have a fever after a head injury? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Have you vomited after a head injury?
When to See a Doctor See significance of vomiting if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Have you had continuous, violent vomiting for 15 minutes or longer? Yes Have you vomited more than 3 times in the past 6 hours? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have a headache after a head injury?
When to See a Doctor See significance of a headache if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Do you have a severe headache? Call your health professional today if you answer "Yes" to the following question. Yes Have you had a moderate headache that has not improved within 24 hours after a recent head injury, but you do not have any other symptoms? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Have you had a mild headache that has not improved within 4 days after a recent head injury? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Have you had headaches on and off for 2 weeks or longer after a head injury? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you think an injury was caused by abuse?
When to See a Doctor See significance of an injury caused by abuse if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Was your head injury caused by someone who was trying to hurt you? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Have you had any new or ongoing symptoms after a head injury?
When to See a Doctor See significance of new or ongoing symptoms if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to any of the following questions. Yes Have you had changes in your ability to think, remember, or solve problems? Yes Have you had changes in your ability to concentrate? Yes Have you had changes in your personality? Yes Do you have dizziness, lightheadedness, or unsteadiness that makes it hard to stand or walk (ataxia)? Yes Do you have blurred or double vision? Yes Do you have ringing in your ears or hearing loss in one or both ears? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Do you have any mild symptoms of a concussion that did not develop until 1 to 2 weeks after a head injury? Yes Have you had mild symptoms of a concussion for more than 4 weeks after a head injury? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.

Other Symptoms to Watch For

Do you have any of the following symptoms?

• Neck pain: Go to the topic Neck Pain.
• Back pain: Go to the topic Back Pain.
• Fever: Go to the topic Fever, Age 4 and Older.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

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, return to the Emergencies and Check Your Symptoms sections of this topic 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.
  • Difficulty speaking or slurred speech.
  • Blurred or double vision.
  • 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 difficulty moving.
  • Significant changes in the pupils.
  • Vomiting that continues after the first 2 hours.
  • A severe headache or stiff neck that is getting worse or not improving after the first 4 hours.
  • Abnormally deep sleep, difficulty waking up, or extreme sleepiness.
• If there is bleeding, apply firm pressure directly over the wound with a clean cloth or bandage for 15 minutes. See how to stop bleeding. 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 closely for at least 24 hours after 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 or Panadol, 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 (postconcussive syndrome).

Rest

• Rest is the best treatment for a mild 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 or Panadol, to relieve a mild headache or pain from the injury. Do not use other nonprescription or prescription medications 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 (120 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 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 or Panadol, to relieve a mild headache or pain from the injury. Do not use other nonprescription or prescription medications 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

Use the Check Your Symptoms section to evaluate the symptoms if any of the following occur during home treatment.

• Bleeding has not stopped after 15 minutes of direct pressure.
• Bruising or discoloring behind the ears or around the eyes develops after a head injury.
• Other symptoms develop, such as:
  • Seizure activity.
  • Confusion or not acting normal. Ask the injured 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.
  • Difficulty speaking or slurred speech.
  • Blurred or double vision.
  • Vertigo, lightheadedness, or unsteadiness that prevents standing or walking.
  • Symptoms that affect one side of the body more than the other side, such as numbness, weakness, or difficulty moving.
  • Significant changes in the pupils.
  • Vomiting.
  • A severe headache or stiff neck that is getting worse or not improving after the first 4 hours.
  • Abnormally deep sleep, difficulty waking up, or extreme sleepiness.
• Symptoms become more severe or more frequent.

You can help prevent head injuries.

• Wear your seat belt when in a motor vehicle. Use child car seats.
• 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, skate boarding, 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 firearms in your home. If you must keep firearms, lock them up and store them unloaded and uncocked. Lock ammunition in a separate area.

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

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

• How and when 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 home treatment measures have you used to treat the head injury?
• 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 prescription or nonprescription medications do you use?
• Were alcohol or drugs involved in the injury?
• Do you have any health risks?

• Bruises and Blood Spots Under the Skin
• Cuts
• Nausea and Vomiting, Age 4 and Older
• Neck Problems and Injuries
• Nosebleeds
• Physical Abuse
• Puncture Wounds
• Scrapes
• Stress Management
• Traumatic Brain Injury (Concussion)

Citations

1. Evans RW (2003). Mild head injury and the postconcussion syndrome. In Saunders Manual of Neurologic Practice, pp. 488–493. Philadelphia: Saunders.

Author:	Sydney Youngerman-Cole, RN, BSN, RNC	Last Updated: July 12, 2006
Medical Review:	William M. Green, MD - Emergency Medicine H. Michael O'Connor, MD - Emergency Medicine
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