Head Trauma (Traumatic Brain Injury)

Don't move a person with a head injury unless it is necessary to save their life. Call 911 and wait for help. Head trauma often comes with a severe neck injury. Sudden movements can result in paralysis.

Call 911

Call 911 right away after a head blow that results in:

• Prolonged loss of consciousness (more than a few seconds) or prolonged drowsiness

• Memory problems or confusion

• Severe headache

• Nausea or vomiting

• Pupils dilated or different sizes

• Blurred or double vision

• Severe bleeding

• Blood or watery fluid leaking from the nose or ears

• A broken skull or a soft spot on the skull

• Slow breathing

• Loss of balance, vertigo, or loss of coordination

• Weakness of or trouble using an arm or leg

• Slurred speech

• Seizure

• Sensitivity to light or sound

• Hearing problems, such as ringing in the ears

What to expect in the ER

Here is what will happen: 

• A neurological exam is done. This is a series of simple questions and tests that evaluate the nervous system. During this exam, the following are assessed:

  • Reflexes

  • Movement

  • Response to commands

  • Vision, hearing, and speech

  • Coordination and balance

  • Response to pain

  • Mental state

• The healthcare provider shines a bright light into the eyes to check how the pupils respond. This can reveal more about any head injuries.

• A head CT scan may be done. This test combines X-rays and computer scans to create detailed images of the brain to detect bleeding, swelling, brain injury, and skull fractures.

• An MRI scan may be done on the head. This test detects minute bleeding (micro hemorrhage), bruising, swelling, and scarring that may not be visible on CT scanning.

• In some cases, a brain perfusion single photon emission computed tomography (SPECT) may be done. This measures cerebral blood flow and activity patterns to evaluate traumatic head injuries.

Treatment for head trauma

Many factors—including the size, severity, and location of the brain injury—affect how a TBI is treated and how quickly a person might recover. Here is what is generally done: 

• Sometimes, severe head injuries cause bleeding on or in the brain that needs to be treated right away with surgery. In certain cases, the injured person will be watched closely and taken for surgery only if the injuries become worse. After surgery, special care is needed to prevent further brain damage.

• Minor head trauma may need little treatment beyond pain control and observation. The healthcare provider may suggest using cold packs to reduce swelling and pain.

Once you are home

At home, call 911 right away if the affected person:

• Becomes very drowsy or confused

• Has a headache or trouble seeing

• Has a stiff neck or muscle weakness

• Vomits

• Has seizures

• Has bruising around the eyes or behind the ears

• Has any blood or clear fluid coming out of the ears or nose

Other considerations

For mild head trauma, the person may need to take a short time off from work or school, although usually no more than 2 to 3 days. Ask their healthcare provider for written instructions about when they can safely return to work, school, sports, or other activities, such as driving a car, riding a bike, or working with heavy machinery.

Make an appointment for a follow-up visit with their healthcare provider to check their progress.

Ask their healthcare provider about new or persistent symptoms and how to treat them.

Pay attention to any new signs or symptoms even if they seem unrelated to the injury (for example, mood swings or unusual feelings of irritability) These symptoms may be related even if they occurred several weeks after the injury.