What to do if you hit your head and when to seek treatment

What to do if you hit your head and when to seek treatment

Head injuries can be as serious as a concussion, skull fracture, internal bleeding and brain damage. In fact, head injuries are a leading cause of disability and death in adults. However, they can also be as minor as a bump, bruise, or cut on the head. And not every blow to the head results in an injury.

That's why it's important to know what types of head injuries can occur from a blow to the head and when to see a doctor.

What is a traumatic brain injury?

A traumatic brain injury (TBI) is a head injury caused by a shock, blow, or jolt to the head or body, or a penetrating head injury. A TBI results in disruption of normal brain function.

TBIs can occur from direct blows to the head, vehicle accidents, or inflicted injuries (such as an assault or suicide attempt), said Angela K. Lumba-Brown, MD, clinical assistant professor of emergency medicine and neurosurgery at Stanford School of MedicineThe health.

However, the majority of these TBIs occur during falls, said Dr. Lumba Brown. Falls are the second leading cause of death related to TBI.

After suffering a “significant blow to the head” in January 2021, comedian and actor Bob Saget was found dead in his hotel room in Orlando, Florida, according to a statement from his familyThe Hollywood ReporterThe 65-year-old “accidentally hit the back of his head, thought nothing of it and fell asleep.” An autopsy report later determined that Saget had multiple skull fractures and brain hemorrhages.The New York TimesReports.

Life-threatening brain injuries like Saget's are not uncommon: About 61,000 people died from TBI in 2019, according to the Centers for Disease Control and Prevention (CDC).

While TBIs can lead to serious medical complications, including brain bleeding, swelling and death, knowing when to seek emergency medical care for yourself or someone else can be life-saving. Here's what you need to know about traumatic brain injuries and what to do if you hit your head (especially if you're alone).

Head injuries explained

The different types of head injuries include:

Concussion:This is a devastating brain injury. You can remain conscious. You may feel dizzy or have vision problems, headaches, neck pain, or other changes in cognitive function.Brain contusion:This is a bruise on the brain. Minor bleeding in your brain causes swelling.Skull fracture:That's a crack in your skull. Sometimes the broken skull bones can cut into your brain, causing bleeding and can lead to further injury. Broken skull bones can also rupture (cut) an artery in your skull and cause a buildup of blood that presses on your brain, known as an epidural hematoma.Hematoma:This is a collection of blood that can occur inside the skull next to the brain or outside the skull under the scalp. It may appear immediately or last for several days.

TBIs occur on a spectrum – the most common being a mild TBI or a concussion. Hitting your head on a closet door, falling, or injuring yourself while playing sports can lead to one of these mild TBIs, Dr. Lumba Brown.

And while there may be pain and neurological symptoms associated with a concussion, a brain scan will not show findings such as bleeding, bruising or swelling, Dr. Lumba Brown added. The CDC says people with a mild TBI or concussion usually feel better within a few weeks.

However, moderate or severe TBIs show up on brain scans - usually in a variety of ways. Hematomas — particularly epidural hematomas or subdural hematomas — are one way a TBI can manifest, said Anthony P. Kontos, PhD, director of the Sports Medicine Concussion Program at the University of Pittsburgh Medical CenterThe health.

An epidural hematoma involves bleeding from a ruptured blood vessel in the space between the skull and the covering around the brain, called the dura mater. A subdural hematoma is where a ruptured blood vessel bleeds between the dura mater and the area just outside the brain (arachnoid).

Moderate to severe TBIs can also include contusions, bruising of brain tissue; or hemorrhage – both intracerebral hemorrhage and subarachnoid hemorrhage – which occurs when active bleeding is present.

These moderate to severe TBIs can be particularly dangerous - any type of bleeding or swelling in the skull can increase pressure in the brain (known as increased intracranial pressure), which is a life-threatening situation, says George T. Chiampas, DO, assistant professor of emergency medicine and orthopedic surgery at Northwestern University Feinberg School of Medicine, tellsThe health.

The extra pressure in the brain can put pressure on brain structures and restrict blood flow, which can lead to serious brain damage or death.

TBIs can also progress from one degree to another, which is why it's so important to see a doctor if you're concerned. “[Epidural and subdural hematomas] can occur several days or even weeks after a head injury, so it is important to remain vigilant and monitor your symptoms,” Kontos said. “Don’t hesitate to go to the emergency room if anything feels uncomfortable.”

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Who is most at risk for complications from head injuries?

TBIs can affect anyone, but some people are at higher risk of serious problems than others. For example, people with blood clotting disorders are at higher risk of complications, Dr. Lumba Brown. People over 65, who have thinner blood vessels and smaller brains, are also at higher risk of serious injury.

Those with a condition called osteopenia, which causes people to lose bone mass and increase the risk of skull fractures, are also considered high-risk.

Taking blood thinners (including aspirin) is also an important risk factor. “Because blood thinners prevent blood clots from forming, even small cuts or bruises bleed much more,” Kontos said. “For this reason, blood thinners can increase the risk of bleeding in the brain.”

Finally, people who may have difficulty explaining their symptoms - young children, people with dementia or memory problems, or patients with a substance use disorder - are at higher risk, Dr. Chiampas.

How to tell if you have a head injury

If you bump your arm or sprain your ankle, you can usually see physical signs of an injury that might prompt you to seek medical attention. Brain injuries, on the other hand, are not visible.

"It's very different from other injuries where you might see bruising on your skin or swelling in your ankle," said Dr. Chiampas. “That’s why it’s so important to be aware of the development of symptoms and when to address them.”

Symptoms of a mild TBI and concussion include:

Sensitivity to light or noise Dizziness or problems with balance Tiredness, no energy Headache Nausea or (early) vomiting Vision problems Attention or concentration problems Feeling slowed down Light-headedness or light-headedness Problems with short or long-term memory Difficulty thinking clearly Anxiety or nervousness Irritability or easily annoyed Feeling emotional sadness Sleeping less than usual Sleeping more than usual Difficulty falling asleep

When should you see a doctor after a head injury?

It's always a good idea to get checked out by a doctor after a head injury, even if it's a minor injury. Kontos said concussions can worsen existing problems such as migraines, motion sickness, and anxiety and mood disorders.

Because head injuries can worsen over time, the input of a healthcare provider can also help you monitor your symptoms and impairments to ensure they do not worsen.

Research suggests seeking medical help within a week of a minor head injury - a 2020 study found that people who suffered a head injury and sought medical attention within a week recovered faster than those who waited longer to seek help.

Seeking input from a healthcare provider is also important to reduce the risk of other health complications from a TBI. Research in 2022 found that endocrine and cardiovascular conditions following TBI were significantly higher in patients with mild or moderate-to-severe TBI than in patients without TBI.

However, moderate and severe TBIs require immediate emergency care, Kontos said. If you have any of these “red flag” symptoms after a head injury, call 911 or have someone take you to the emergency room immediately:

Loss of consciousness for a long period of time Severe headache A pupil that is larger than another Dizziness Any type of weakness or reduced coordination Speech problems Confusion or difficulty thinking Seizures (trembling or twitching) for any period of time Drowsiness or inability to wake up Repeated nausea or vomiting

Aside from noticeable symptoms, Dr. Lumba-Brown said anyone considered at high risk for complications from a head injury should be seen by a doctor immediately. If you suffer a head injury while you are alone, you should also take extra precautions, such as: For example, telling someone else about your head injury or calling your doctor (or scheduling a telemedicine session) to find out if and when you should seek treatment.

And if you find yourself restless sleeping after a head injury — even a relatively minor one — it's also in your best interest to talk to a healthcare provider. "A medical professional can evaluate whether your sleepiness is normal or whether it is representative of a progressive brain injury," said Dr. Lumba Brown.

Of course, it's also important to prevent TBIs in the first place, said Dr. Lumba Brown. Preventative measures may include always wearing a seat belt and helmet when in a vehicle when you should (e.g., while riding a bike, skiing, or skateboarding). At home, you can also keep walkways clear, clean up spills, avoid placing loose rugs on the floor, and avoid risky behaviors like standing on chairs and climbing countertops or ladders—especially when you're alone.

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A quick review

Head injuries can be as serious as a concussion, skull fracture, internal bleeding, and brain damage or as minor as a bump, bruise, or cut on the head. While TBIs can lead to serious medical complications, including death, knowing when to seek emergency medical care for yourself or someone else can be life-saving.