Head Injury, Age 4 and Older

British Columbia Specific Information

Knowing the signs and symptoms of a serious head injury will help you get the right care. Speak with a health care provider about the injury as soon as possible. If you think a head injury might be serious, call 9-1-1 or visit an emergency department right away. For non-emergency information or advice, call 8-1-1 to speak with a registered nurse any time of the day, every day of the year.

If your child’s health care provider finds no signs of a serious head injury, you may be advised to monitor your child in the hours, days and weeks following the injury. Only when your child’s health care provider advises you that it is safe for your child to go home in your care, follow the advice on caring for your child at home:

BC Children’s Hospital – Head Injury Advice for Parents and Caregivers

For more information about head injury, including concussion recognition, diagnosis, treatment and management, see:

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. Teenagers 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 injuries at work. 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. Adults age 65 or older, who have had a fall, need to be seen by a doctor right away, even if you don't see any symptoms.

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 (post-concussive 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 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. Be sure to check for other injuries to the face, mouth, or teeth whenever there is 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

How old are you?

Less than 4 years

4 to 59 years

60 years or older

Are you male or female?

Male

Female

The medical assessment of symptoms is based on the body parts you have.

If you are transgender or non-binary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
If your symptoms aren’t related to those organs, you can choose the gender you identify with.
If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.

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

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

Do you think there could be a spinal cord injury?

Yes

Possible spinal cord injury

Are there any signs that the head injury is serious?

These could appear at the time of the injury or later.

Yes

Symptoms of serious head injury

Did a seizure occur after the head injury?

Yes

Seizure after head injury

Did the seizure occur within the past 2 days (48 hours)?

Yes

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

Are there any symptoms of a skull fracture?

Yes

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

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

Did you pass out (lose consciousness) after the injury?

Yes

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, a hard blow to the head, a car crash, or a forceful sports injury.

Yes

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

Have you vomited more than once since the injury?

Yes

Vomited more than once after injury

Do you suspect that the injury may have been caused by abuse?

This is a standard question that we ask in certain topics. It may not apply to you. But asking it of everyone helps us to get people the help they need.

Yes

Injury may have been caused by abuse

Do you take a medicine that affects the blood's ability to clot?

This may include blood thinners and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen. These medicines can cause bleeding and can make it harder to control bleeding.

Yes

Takes medicine that affects blood's ability to clot

Have you had any memory loss after the injury?

Yes

Memory loss after injury

Have you been getting headaches?

Yes

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

Are there any other symptoms that may be related to the head injury?

Some symptoms may appear days or even more than a week after a head injury.

Yes

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

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, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, or natural health products 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.

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.

HomeTreatment

RelatedInformation

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.

Shock is a life-threatening condition that may quickly occur after a sudden illness or injury.

Adults and older children often have several symptoms of shock. These include:

Passing out (losing consciousness).
Feeling very dizzy or light-headed, 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 serious head injury may include:

Passing out.
Confusion.
Repeated vomiting.
Worsening headache.
Extreme sleepiness.
Unsteady walking.
Slurred speech.
A difference in the size of the pupils of the eyes.
New vision problems.

Other symptoms related to a head injury that may appear later include:

Repeated episodes of feeling dizzy or light-headed.
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.

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.

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.

HomeTreatment

RelatedInformation

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.

HomeTreatment

RelatedInformation

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Sometimes people don't want to call 911. They may think that their symptoms aren't serious or that they can just get someone else to drive them. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Call911 Now

Based on your answers, you need emergency care.

Call 911 or 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 may have a spinal injury from diving into the water 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.

HomeTreatment

RelatedInformation

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

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

Head Injury, Age 3 and Younger

Home Treatment

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 prime minister.
- Severe irritability or wanting to fight.
- Inability to remember what happened just before or after the injury.
- Trouble speaking or slurred speech.
- Dizziness, light-headedness, 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 "ose 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

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 "ose 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 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.

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 non-prescription 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 125 mL (4 fl oz) 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 ne for 12 to 48 hours. Gelatin dessert, dry toast, crackers, and cooked cereal are od 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 non-prescription 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 a?
- 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 non-prescription 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?