Head injuries range from simple bumps to severe trauma affecting brain function. Determining the appropriate level of care quickly is paramount, as a delay in treatment for a serious injury can lead to long-term complications. The decision to seek emergency care depends on an immediate assessment of the person’s symptoms and the nature of the impact. Understanding the criteria for mild versus severe injury guides appropriate triage and intervention.
Immediate Actions Following a Head Injury
The first steps following any head impact involve ensuring the person’s immediate safety and checking for responsiveness. If the person is conscious, they should be instructed to lie down with their head and shoulders slightly elevated for comfort and stabilization. If the mechanism of injury suggests potential neck or spinal trauma, such as a fall from a height or a motor vehicle accident, the person must be kept completely still until emergency medical personnel arrive.
A cold compress, such as a bag of frozen vegetables wrapped in a cloth, can be applied to the injury site for up to 20 minutes to reduce swelling and pain. Check for signs of breathing and circulation; if the person is unresponsive and not breathing, initiate cardiopulmonary resuscitation (CPR) immediately. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin should be avoided for pain relief in the acute phase of a head injury. These medications inhibit platelet aggregation and can increase the risk of internal bleeding within the skull.
High-Priority Symptoms That Demand Emergency Care
Certain symptoms act as “red flags” indicating a severe traumatic brain injury (TBI) requiring an immediate call to emergency services. Any loss of consciousness or brief alteration of awareness immediately following the injury necessitates emergency assessment, even if the person appears recovered afterward. A headache that is persistent, rapidly worsening, or described as the “worst headache of life” suggests increasing pressure inside the skull.
Repeated or projectile vomiting, especially multiple episodes, is a sign of elevated intracranial pressure and requires immediate medical attention. Neurological deficits, such as profound confusion, slurred speech, or difficulty recognizing familiar people or places, are indicators of brain dysfunction. The onset of seizures or convulsions also signals abnormal electrical activity in the brain.
Signs of a skull fracture, like bruising around the eyes (raccoon eyes) or behind the ear (Battle’s sign), warrant emergency care. The discharge of clear or bloody fluid from the ears or nose may signal a cerebrospinal fluid leak, meaning the protective barrier around the brain has been compromised. Other severe symptoms include:
- New weakness, numbness, or loss of coordination in the limbs.
- Significant changes in vision, such as double vision or pupil size discrepancy.
Symptoms Suitable for Home Monitoring and Rest
When symptoms are mild, non-worsening, and there was no loss of consciousness, home monitoring may be appropriate for a mild concussion or simple scalp injury. Minor symptoms include a mild headache that improves with rest, slight light-headedness, or minor fatigue. Small cuts or bruises on the scalp that are not actively bleeding are also manageable at home.
Home management centers on immediate physical and cognitive rest for the first 24 to 48 hours. This includes avoiding mentally demanding tasks, such as reading, screen time, or schoolwork, to allow the brain to conserve energy for healing. Acetaminophen (Tylenol) is the preferred pain reliever for headaches, as it does not carry the same bleeding risk as NSAIDs.
A responsible adult must remain with the injured person for at least the first 24 hours to monitor for any delayed or worsening symptoms. If the person sleeps, they must be easily roused and able to answer simple questions. If mild symptoms intensify, change in nature, or if any high-priority symptoms develop, emergency care must be sought immediately.
Medical Assessment and Next Steps
Upon arrival at the emergency department, the medical team will conduct a thorough assessment, beginning with a detailed neurological exam. This evaluation checks reflexes, balance, coordination, memory, and cognitive status to establish a baseline and identify any focal neurological deficits. The physician uses the patient’s symptoms and the mechanism of injury to determine the need for diagnostic imaging.
A non-contrast computed tomography (CT) scan is the primary imaging tool used to quickly rule out acute issues like skull fractures or bleeding within the brain tissue or surrounding membranes. If symptoms are mild and the neurological exam is normal, imaging may be deferred to avoid unnecessary radiation exposure.
For patients diagnosed with a concussion, the next steps involve strict instructions for post-concussion care. This recovery phase focuses on cognitive rest, which may last several days or weeks depending on symptom resolution. A gradual return to activity is recommended, where physical and mental tasks are slowly reintroduced as long as they do not cause symptoms to reappear or worsen. This structured approach ensures a full recovery and minimizes the risk of prolonged post-concussion syndrome.