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Head Injury, Age 4 and Older

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.

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

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 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.

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.

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.

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.

Call 911 Now

Based on your answers, you need emergency care.

Call911or other emergency services now.

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

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.

Call 911 Now

Based on your answers, you need emergency care.

Call911or 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.

Call 911 Now

Based on your answers, you need emergency care.

Call911or 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.

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.

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.
  • 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.

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 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.
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 (postconcussive syndrome).

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

By Healthwise Staff
William H. Blahd, Jr., MD, FACEP - Emergency Medicine
H. Michael O'Connor, MD - Emergency Medicine
Last Revised November 16, 2012

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

© 1995-2014 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.

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