Head Injury: What to Expect

Head injuries can cause damage to the brain or skull. Prevention is important and can include habits like wearing a helmet when riding a bicycle or wearing a seat belt while in a moving car.

Mild head injuries are fairly common and don’t cause lasting problems. However, it can be hard to tell whether a head injury is mild or serious. Get medical attention if you think you might be experiencing symptoms after a head injury. Prompt and appropriate care can make the difference between lasting brain damage and a full recovery.

This article will discuss types of head injuries, common causes, symptoms, when to see a healthcare provider, diagnosis, treatment, and prevention.

 Types of Head Injuries

There are several types of head injuries. Generally, more severe head injuries involve more than one type. 

Types of head injuries: 

• Scalp laceration: The scalp can be hit by something sharp, causing a cut.
• Concussion: Head pain, and a brief change in awareness or thinking occurs due to intense shaking or sudden head movements.
• Fracture: A hard blow to the skull may cause a crack in the bone. If the bones do not shift, they will heal properly with time.
• Contusion: A bruise may develop in the brain tissue.
• Hemorrhage: Bleeding may occur when a blood vessel tears due to head trauma. The blood can accumulate in different spaces, causing a subarachnoid hemorrhage, subdural hematoma, or epidural hematoma.

Another type of head injury, chronic traumatic encephalopathy (CTE), is a progressive condition that develops from repeated concussions. This extensive brain damage can cause serious problems with memory, thinking, and emotions. 

Common Causes

Any blow to the head can cause a head injury. An intense, rapid bump is more likely to cause a head injury than a gentle or slow bump. 

Causes can include: 

• Motor vehicle accidents, including cars, motorcycles, bicycles, and other recreational vehicles 
• Falling 
• Sports injuries 
• Getting hit in the head by an object, such as a ball
• Violent injuries 

With head trauma, damage can occur due to the following physical changes:

• Microscopic damage can affect brain chemicals and brain function, causing a concussion.
  
• The brain may move within the skull, banging into the skull and causing a contusion.
• A blood vessel can tear due to brain movement within the skull, causing a hemorrhage.
• The meninges (the lining surrounding the brain and spinal cord) may tear, allowing cerebrospinal fluid (CSF) to escape, potentially increasing the risk of a CSF leak or infection. 

After head trauma, any combination of these injuries can occur. For example, a severe, penetrating head injury can cause a scalp laceration, fracture, contusion, concussion, and bleeding. 

Symptoms

After a head injury, symptoms usually begin immediately, especially if the injury is serious, but some symptoms might not start until several days later. Head pain is the most common immediate symptom.

Common symptoms of a head injury include:

• Head and neck pain 
• Dizziness 
• Photophobia (discomfort when looking at normal light)
• Wanting to take it easy 

Serious symptoms after a head injury include: 

• Nausea 
• Vomiting 
• Unusual sleepiness or lethargy 
• Seizures or convulsions 
• Weakness on one side of the face or body
• Vision changes or double vision 
• Blood coming from the ear 

Some of the symptoms of a head injury depend on the type and severity of the injury:

• A laceration can cause bleeding.
• A concussion may cause some loss of memory of the time right before or right after the injury 
• A fracture might not cause symptoms, or it can cause pain.
• A contusion may cause head pain and stroke-like symptoms, such as weakness in one side of the body.
• A hemorrhage can cause severe head pain, neck stiffness, convulsions, and changes in consciousness.

Severe head injuries can also increase the risk of dementia later in life.

When to See a Healthcare Provider

After any head injury, even if it seems mild, get medical attention if you or someone else develops the following symptoms: 

• Visible bleeding
• Severe head or neck pain 
• Vision changes 
• Trouble with movement or balance 
• Nausea or vomiting 
• Difficulty hearing 
• Severe tiredness 
• Changes in consciousness or changes in behavior 
• Memory problems 
• Involuntary movements or seizures 

Diagnosis

Your evaluation for a head injury should be soon after the injury. Don’t delay getting to a healthcare provider if you’re having symptoms. 

The diagnosis is meant to identify the type and severity of the head injury and to determine the next steps for treatment. Your healthcare provider will talk to you about what happened, your immediate symptoms, and any later developing symptoms if it’s been a while since your injury. 

You will have a comprehensive neurological examination, which can detect evidence of serious brain damage.

Other tests you might have include:

• Concussion testing
• Brain imaging, which can involve computerized tomography (CT), magnetic resonance imaging (MRI), or ultrasound 
• Electroencephalogram (EEG), which can detect changes that may occur with seizures 
• Hearing test
• Vision test or eye exam

The specific tests you would need would be guided by your symptoms and your preliminary evaluation.

Treatment

Head injuries are treated in different ways. Symptomatic treatment usually includes pain management. Rest is usually recommended. Sometimes rehabilitation is needed to regain strength, balance, or other skills. 

Specific treatments may include:

• A skull laceration may heal on its own, but it needs to be cleaned and covered to prevent an infection. Sometimes a laceration needs to be stitched.
• A skull fracture may need immobilization with a soft helmet as it heals.
• The effects of a concussion generally improve over time. Rest and a gradual return to activities are usually recommended after a concussion.
• A contusion cannot be treated, but the damage may partially or fully heal over time. Your healthcare provider might recommend physical therapy or cognitive therapy to help you maximize your abilities. 
• A small hemorrhage may resolve on its own over time. A large hemorrhage may need to be surgically drained. 
• Rarely a meningeal tear may need to be surgically repaired. 
• Steroids and fluid management may be needed if a head injury causes swelling in the brain. 
• Post-injury seizures can be prevented with anti-seizure medication. This is often prescribed for people who develop post-traumatic seizures. 

Head injuries may lead to emotional and personality changes, which can be made worse if the incident causing the injury was traumatic. Counseling and psychological therapy can help with coping after a severe head injury. 

Prevention

Head injuries can't always be prevented, but there are some precautions you can take. If you participate in sports that cause direct head trauma, such as boxing or football, wearing a proper helmet can reduce the risk of injuries.

Additionally, it's important to wear a proper-fitting helmet when riding a motorcycle or a bicycle, because there is a risk of falling.

Summary 

The effects of a head injury can range from mild to severe. Head injuries can involve the scalp, skull, meninges, brain, or blood vessels. Recovery can take time, and serious injuries may require treatment with surgery or other medical interventions. Medication and rehabilitation can help throughout the recovery period.

A Word From Verywell 

If you or someone you care about has had a head injury, it’s normal to feel stressed and uncertain. Healing and recovery can be a slow process. Usually there’s steady improvement.

If your improvement lags or if you backslide a little, be reassured that this is expected and it’s not necessarily a sign of any problem. Discuss any concerns you have with your healthcare team, who will help you get through the next steps of care and into recovery.