A head injury is a blow or jolt to the head that temporarily disrupts the brain’s normal function. While most head bumps are minor, the skull’s rigid structure means internal damage, such as swelling or bleeding, can occur even without a visible external cut or bruise. Recognizing the signs of a severe injury is important because internal complications can develop rapidly. This guidance will help you determine when symptoms warrant immediate emergency intervention versus when they require a scheduled medical assessment or home monitoring.
Immediate Red Flags: When to Call 911
Certain signs indicate a medical emergency where the brain may be under severe threat from internal bleeding or mounting pressure. Call emergency services immediately if the injured person experiences any loss of consciousness, even if brief, as this signals a significant disruption of brain function. An inability to wake the person up or increasing difficulty keeping them awake suggests progressive deterioration. Seizures or convulsions following head trauma also require immediate attention, indicating abnormal electrical activity within the injured brain tissue.
Signs of a potential skull fracture or massive internal bleed also require an emergency response. These include the leaking of clear or pink-tinged fluid or blood from the ears or nose, which may indicate a tear in the protective layers around the brain. Severe bruising around the eyes (“raccoon eyes”) or behind the ears (“Battle’s sign”) are indicators of a skull base fracture. Rapid worsening of confusion, agitation, or restlessness suggests that pressure inside the skull is increasing quickly.
The presence of pupils of unequal size, where one is noticeably larger than the other, can signal pressure on the brainstem. Any sudden weakness, numbness, or decreased coordination on one side of the body, or difficulty with walking or balance, should also trigger a 911 call. These focal neurological deficits suggest that a specific region of the brain is being damaged, requiring emergency stabilization.
Assessing the Injury: Indicators for an Emergency Room Visit
If the person is conscious, alert, and does not exhibit immediate red flags, assess their symptoms to determine the need for an emergency room evaluation. A persistent or worsening headache is a common reason to seek urgent care, especially if the pain increases or does not respond to standard pain relievers. This pain progression can signal slow bleeding or swelling within the cranial cavity.
Repeated vomiting or persistent nausea is another strong indicator for an emergency assessment; while one episode may be due to shock, multiple episodes suggest elevated intracranial pressure. Also look for persistent dizziness, lightheadedness, or a noticeable lack of coordination that makes simple tasks difficult. Changes in speech, such as slurring or difficulty finding words, signal a disturbance in the brain’s language centers.
Vision problems, including blurred or double vision, necessitate an emergency assessment, as they can result from injury to the visual processing areas of the brain. Memory loss regarding the event, such as not recalling the moments immediately before or after the impact, is a classic sign of a concussion. These symptoms represent a significant disruption of brain function that requires professional evaluation.
A lower threshold for an emergency room visit must be used for vulnerable populations, including young children and adults over 65. Infants under two years old may show subtle signs, such as persistent crying, refusal to eat, or a bulging soft spot. For adults over 65, age increases the risk of serious complications, especially if they are taking blood-thinning medication. Subtle changes in behavior, such as increased sleepiness or mild confusion, should prompt an immediate trip to the emergency department for these groups.
Delayed Symptoms That Demand Medical Attention
Serious symptoms can manifest hours or even days after the initial head injury, even if the person felt fine immediately following the impact. This delay occurs because the brain’s response to trauma, such as swelling or chemical changes, takes time to affect neurological function. If a person was monitored at home or discharged from the emergency room, they must continue to watch for these delayed signs.
Subtle neurological and cognitive changes often indicate an ongoing concussion or post-concussive effect requiring follow-up with a primary care provider or neurologist. These symptoms include mental fogginess, difficulty concentrating, or a reduction in the speed of thinking. The person may find they cannot perform usual work or school tasks without feeling overwhelmed or exhausted.
Common Delayed Symptoms
Delayed symptoms that warrant a medical evaluation include:
- Persistent sleep disturbances, such as insomnia or sleeping much more than usual.
- Mood changes, including new or increased irritability, anxiety, or depression.
- New or persistent sensitivity to light or noise.
- Changes in the sense of taste or smell.
These symptoms indicate the brain has not fully recovered and needs support and management. They should not prompt a return to the emergency room unless they suddenly worsen or are accompanied by severe headache or vomiting. A non-emergency medical appointment is necessary to establish a diagnosis and develop a structured recovery plan.
Monitoring and Managing the Initial Recovery Phase
For a mild head injury monitored at home or after hospital discharge, the initial 24 to 48 hours require relative physical and cognitive rest. This means avoiding strenuous activity and limiting tasks that require intense concentration, such as reading or video games. Limiting activities that worsen symptoms is helpful for the brain to begin its recovery.
A responsible adult must stay with the injured person for at least the first 24 hours to monitor for developing red flags. It is acceptable for the person to sleep, provided they are easy to wake and do not show signs of increasing confusion or difficulty staying awake. The monitor should check on the person periodically to ensure their alertness remains stable.
It is important to avoid substances that could interfere with the brain’s healing or mask a worsening condition. Avoid alcohol and non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin, which can increase the risk of bleeding. Acetaminophen is generally safe for managing headache pain during this initial phase.