Concussion and Head Injury

Introduction

Trauma to the head and traumatic brain injury (TBI) occur due to a direct blow, strike or jolt to the head and include injuries ranging from simple scalp lacerations (cuts) or abrasions (scrapes), to concussions, skull fractures, or severe swelling or bleeding in the brain. Lacerations and skin wounds are discussed later in the guide. In mild TBI, there is generally no loss of consciousness and often a mild headache. In moderate TBI, there may be transient loss of consciousness, temporary blurred vision, headache, dizziness, nausea, vomiting and transient amnesia or confusion. More severe traumatic injury to the brain can cause bleeding in the brain or skull fractures, leading to prolonged loss of consciousness, severe headache, protracted vomiting, lowered heart rate or erratic breathing, decreased responsiveness or coma.

A mild or moderate traumatic brain injury, where trauma to the head results in a temporary change in brain function, is sometimes called a concussion.

Treatment

For moderate and severe head trauma and brain injury, you must seek medical attention immediately as severe TBI is a life-threatening condition that can cause rapid deterioration and death. Any trauma to the brain that causes swelling or bleeding will increase the pressure inside the skull and can be fatal quickly. In these cases, immobilize the patient's spine and immediately evacuate the patient to the nearest medical care.

Mild head injuries with no loss of consciousness and only mild headache are usually not serious or life-threatening and the headache can be treated with ibuprofen or acetaminophen. After mild head injury precautions should be taken to prevent a second traumatic injury to the brain, as this can compound symptoms and cause worsening of concussion.

Some head injuries that initially seem minor can cause slow bleeding in the brain that causes deterioration and death hours later. Therefore, someone who experiences a mild or moderate head injury should be observed for at least 24 hours for any change in behavior. If you are traveling alone and experience a head injury but decide not to seek medical attention, you should still seek out other people who could call for help if you get worse.

In someone who has had a mild head injury without loss of consciousness and has been behaving normally for many hours, it is generally not necessary to awaken them during the night to check on them.

When To Worry

Seek immediate medical care after a head injury if you have any of the following:

  • headache that is severe or worsens over time
  • deterioration in mental status
  • seizures or convulsions
  • persistent vomiting
  • clear fluid draining from the nose (could indicate leakage of cerebrospinal fluid)
  • bruising behind the ears or around the eyes when that was not the site of injury (could indicate bleeding in the brain)

Pediatrics

Quick Guide

If you have

  • A head injury without loss of consciousness and
    • mild headache
    • mild nausea
    • mild dizziness
    • mild sensitivity to light and sound

You may have

a concussion

Rest, and prevent a second injury

Consider

ibuprofen (generic for Motrin®) 400 mg every 6 hours as needed for pain

OR

acetaminophen (generic for Tylenol®) 650 mg every 6-8 hours as needed forpain (do not exceed 3000 mg per day)

AND

ondansetron 4 mg every 6 hours as needed for nausea

OR

Pediatrics

For children age 17 and under

ibuprofen 10 mg/kg every 6 hours as needed; maximum 400 mg per dose

acetaminophen 15 mg/kg every 6 hours as needed; maximum 500 mg per dose

ondansetron (generic for Zofran®) 4 mg every 6 hours as needed; can be used in children over the age of 4

See also: Pediatrics

If you have

  • a head injury with loss of consciousness AND
    • a seizure or convulsions
    • severe headache
    • vomiting
    • vision changes
    • a change in mental status
    • signs of a skull fracture such as clear fluid from the ears or nose or bruising around the eyes and ears

Seek emergency medical care

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