Head Trauma (Head Injury)

First aid for a head injury

1. Check responsiveness and breathing. If unconscious and not breathing normally, call 911 and start CPR if trained.
2. Assume a neck injury after a significant fall or crash. Keep the head and neck still. Do not move the person unless they are in danger.
3. Stop bleeding from scalp cuts with firm pressure using a clean cloth. Scalp wounds bleed heavily. If you feel a dent or bone, press gently around the edges, not on it.
4. Apply a cold pack wrapped in a cloth to a bump for 20 minutes at a time.
5. Watch for danger signs for at least 24 hours. Someone should stay with the injured person overnight.
6. Pain relief: acetaminophen (paracetamol) is preferred for the first day or two. Follow the label dose.

It is fine to let someone sleep after a minor head injury if they are awake and behaving normally before they sleep. There is no need to wake them repeatedly unless a doctor advises it.

Types of head injury

Symptoms to watch for

• headache that worsens
• nausea and repeated vomiting
• confusion, memory problems, slowed thinking
• drowsiness or difficulty waking
• dizziness, poor balance
• blurred or double vision
• sensitivity to light and noise
• irritability or personality change
• slurred speech, weakness, numbness
• seizures

Symptoms of a subdural bleed can appear days or weeks later, particularly in older people. Return to the ER if new symptoms develop.

How doctors assess head injuries

Doctors use the Glasgow Coma Scale (eyes, speech and movement responses) and examine the head, neck, pupils and nervous system. Decision rules, such as the Canadian CT Head Rule for adults and PECARN rules for children, help decide who needs a CT scan. CT is recommended for people with danger signs, a dangerous mechanism, age 65 or over, or those on anticoagulants, among others. Many children with minor head injuries can be safely observed without CT, which avoids radiation.

Treatment

• Minor head injury and concussion: rest for the first 24 to 48 hours, then a gradual, symptom-guided return to normal activities.
• Scalp wounds: cleaning and closure with staples, stitches, glue or hair apposition.
• Skull fractures: many heal without surgery. Depressed fractures may need repair.
• Bleeding in or around the brain: close monitoring, reversal of blood thinners, and surgery to remove clots or relieve pressure when needed.
• Severe traumatic brain injury: intensive care to control brain swelling and pressure, followed by rehabilitation.

Concussion recovery

Most adults recover within 10 to 14 days, and children within about 4 weeks. Recommended steps:

1. Relative rest for 24 to 48 hours, avoiding screens and strenuous activity if they worsen symptoms.
2. Light activity such as walking, then gradually more.
3. Return to school or work with adjustments if needed.
4. Return to sport only after symptoms have resolved and a stepwise return-to-play program is completed, with medical clearance. Never return to play the same day.

Symptoms lasting beyond 4 weeks may be post-concussion syndrome, which benefits from specialist care.

Head injuries in children and older adults

Babies and young children fall often, and most bumps are minor. Large swellings on the side or back of the head in babies under 2, changes in behavior, vomiting or poor feeding need assessment. Unexplained injuries in a baby who is not yet mobile raise concern for abuse.

Older adults are more likely to bleed after minor trauma, especially on blood thinners or aspirin. Confusion, falls or headache in the days or weeks after a fall can signal a subdural hemorrhage.

Prevention

• wear helmets for cycling, skating, skiing and contact sports
• always use seat belts and correctly fitted child car seats
• prevent falls at home: remove trip hazards, add grab bars and lighting, review medicines that cause dizziness
• use stair gates and window guards for young children
• follow concussion protocols in sports

Frequently asked questions

When should I go to the ER after hitting my head?

Go to the ER for loss of consciousness, repeated vomiting, a worsening headache, confusion, drowsiness, seizures, weakness, vision changes, clear fluid from the nose or ears, or if you take blood thinners or are 65 or older. Call 911 for severe symptoms.

What are the signs of a brain bleed after hitting your head?

Signs include a severe or worsening headache, repeated vomiting, drowsiness, confusion, slurred speech, weakness or numbness on one side, unequal pupils and seizures. Some bleeds, especially in older adults, cause symptoms days or weeks later.

Is it safe to sleep after a head injury?

Yes, if the person was awake, talking and behaving normally before falling asleep and has no danger signs. Someone should stay with them for the first 24 hours. If they become hard to wake, confused or vomit repeatedly, get emergency care.

How long do concussion symptoms last?

Most adults recover within 2 weeks, and most children within 4 weeks. A gradual return to normal activity helps. Symptoms that last longer should be assessed, because targeted treatments can help persistent symptoms.

When should I worry about a bump on my toddler's head?

Seek care if your toddler lost consciousness, vomits more than once, is unusually sleepy or irritable, is not acting normally, will not feed, or has a large soft swelling on the side or back of the head. Most small forehead bumps in active toddlers are harmless.