Brain injury; Head trauma
A head injury is any trauma to the scalp, skull, or brain. The injury may be only a minor bump on the skull or a serious brain injury.
Head injury can be either closed or open (penetrating).
- A closed head injury means you received a hard blow to the head from striking an object, but the object did not break the skull.
- An open, or penetrating, head injury means you were hit with an object that broke the skull and entered the brain. This is more likely to happen when you move at high speed, such as going through the windshield during a car accident. It can also happen from a gunshot to the head.
Head injuries include:
- Concussion, in which the brain is shaken, is the most common type of traumatic brain injury.
- Scalp wounds.
- Skull fractures.
Head injuries may cause bleeding:
- In the brain tissue
- In the layers that surround the brain (subarachnoid hemorrhage, subdural hematoma, extradural hematoma)
Head injury is a common reason for an emergency room visit. A large number of people who suffer head injuries are children. Traumatic brain injury (TBI) accounts for over 1 in 6 injury-related hospital admissions each year.
You’ve fallen and hit your head. It hurts a little, but you’re not bleeding and you feel okay. Do you have a head injury, or are you fine? Knowing how to tell a minor head injury from a serious one could literally save your life. Let’s talk about head injuries. Millions of people get head injuries every year. They get into car accidents or fights, they fall, or they get hit in the head while playing sports or working on the job. Most head injuries are minor, because your head comes equipped with its own natural hard hat, a protective skull that surrounds and protects your brain. But sometimes that protection isn’t enough. More than a half-million people each year get head injuries severe enough to send them to the hospital. The most common type of head injury is a concussion. That’s when a hit in the head makes your brain jiggle around in your skull. You can also get a bruise on your brain, called a contusion. Brain contusions are a lot more serious than bruises from a bump on the arm or leg. Other types of head injuries include a fractured skull or a cut on your scalp. If you get hit in the head or fall and you don’t bleed, you’ve got a closed head injury. If an object enters your brain, like glass from a windshield during a car accident or a bullet from a gunshot, then you have an open head injury. It can be very hard to tell if you’ve got a minor closed head injury or a serious one. Your head might look perfectly fine from the outside, when you actually have bleeding or swelling inside your brain. To tell the difference, look for other signs of a serious head injury, such as a severe headache; Clear or bloody fluid coming from your nose, ears, or mouth; Confusion, drowsiness, or a loss of consciousness; Changes in the way you hear, see, taste, or smell; memory loss; mood changes or strange behaviors; slurred speech or recurrent vomiting. If you or someone else has any of these symptoms, call for medical help right away. If you don’t have these symptoms and you think it’s just a minor head injury, you probably don’t need to be treated. Just ask a friend or family member to keep an eye on you. If it’s your child or someone else with the head injury, wake them up from sleep every 2 or 3 hours to ask questions like, Where are you? and What’s your name? just to make sure they’re alert. If you’re in any doubt about whether a head injury is serious, play it safe and get medical help. To play it even safer, protect your head during any activities that could lead to an injury. Wear a helmet whenever you skateboard, roller skate, ski, snowboard, or ride a bike or motorcycle. Put on your seatbelt whenever you’re in the car. And put kids in an age-appropriate car seat or booster seat.
Common causes of head injury include:
- Accidents at home, work, outdoors, or while playing sports
- Physical assault
- Traffic accidents
Most of these injuries are minor because the skull protects the brain. Some injuries are severe enough to require a stay in the hospital.
Head injuries may cause bleeding in the brain tissue and the layers that surround the brain (subarachnoid hemorrhage, subdural hematoma, epidural hematoma).
Symptoms of a head injury can occur right away or may develop slowly over several hours or days. Even if the skull is not fractured, the brain can hit the inside of the skull and be bruised. The head may look fine, but problems could result from bleeding or swelling inside the skull.
The spinal cord is also likely to be injured from falls from a significant height or ejection from a vehicle.
Some head injuries cause changes in brain function. This is called a traumatic brain injury. Concussion is a traumatic brain injury. Symptoms of a concussion can range from mild to severe.
Learning to recognize a serious head injury and give basic first aid can save someone’s life. For a moderate to severe head injury, CALL 911 RIGHT AWAY.
Get medical help right away if the person:
- Becomes very sleepy
- Behaves abnormally, or has speech that does not make sense
- Develops a severe headache or stiff neck
- Has a seizure
- Has pupils (the dark central part of the eye) of unequal sizes
- Is unable to move an arm or leg
- Loses consciousness, even briefly
- Vomits more than once
Then take the following steps:
- Check the person’s airway, breathing, and circulation. If necessary, begin rescue breathing and CPR.
- If the person’s breathing and heart rate are normal, but the person is unconscious, treat as if there is a spinal injury. Stabilize the head and neck by placing your hands on both sides of the person’s head. Keep the head in line with the spine and prevent movement. Wait for medical help.
- Stop any bleeding by firmly pressing a clean cloth on the wound. If the injury is serious, be careful not to move the person’s head. If blood soaks through the cloth, do not remove it. Place another cloth over the first one.
- If you suspect a skull fracture, do not apply direct pressure to the bleeding site, and do not remove any debris from the wound. Cover the wound with sterile gauze dressing.
- If the person is vomiting, to prevent choking, roll the person’s head, neck, and body as one unit onto their side. This still protects the spine, which you must always assume is injured in the case of a head injury. Children often vomit once after a head injury. This may not be a problem, but call a doctor for further guidance.
- Apply ice packs to swollen areas (cover ice in a towel so it does not directly touch the skin).
Follow these precautions:
- DO NOT wash a head wound that is deep or bleeding a lot.
- DO NOT remove any object sticking out of a wound.
- DO NOT move the person unless absolutely necessary.
- DO NOT shake the person if they seem dazed.
- DO NOT remove a helmet if you suspect a serious head injury.
- DO NOT pick up a fallen child with any sign of head injury.
- DO NOT drink alcohol within 48 hours of a serious head injury.
A serious head injury that involves bleeding or brain damage must be treated in a hospital.
For a mild head injury, no treatment may be needed. However, call for medical advice and watch for symptoms of a head injury, which can show up later.
Your health care provider will explain what to expect, how to manage any headaches, how to treat your other symptoms, when to return to sports, school, work, and other activities, and signs or symptoms to worry about.
- Children will need to be watched and make activity changes.
- Adults also need close observation and activity changes.
Both adults and children must follow the provider’s instructions about when it will be possible to return to sports.
When to Contact a Medical Professional
Call 911 right away if:
- There is severe head or face bleeding.
- The person is confused, tired, or unconscious.
- The person stops breathing.
- You suspect a serious head or neck injury, or the person develops any signs or symptoms of a serious head injury.
Not all head injuries can be prevented. The following simple steps can help keep you and your child safe:
- Always use safety equipment during activities that could cause a head injury. These include seat belts, bicycle or motorcycle helmets, and hard hats.
- Learn and follow bicycle safety recommendations.
- Do not drink and drive, and do not allow yourself to be driven by someone who you know or suspect has been drinking alcohol or is impaired in another way.
Hockenberry B, Pusateri M, McGrew C. Sports-related head injuries. In: Kellerman RD, Rakel DP, eds. Conn’s Current Therapy 2020. Philadelphia, PA: Elsevier 2020:693-697.
Hudgins E, Grady S. Initial resuscitation, prehospital care, and emergency room care in traumatic brain injury. In: Winn HR, ed. Youmans and Winn Neurological Surgery. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 348.
Papa L, Goldberg SA. Head trauma. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 34.
Last reviewed on: 9/23/2019
Reviewed by: Jacob L. Heller, MD, MHA, Emergency Medicine, Emeritus, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.