Category: Health & Safety

Responding to a Head Injury or Possible Concussion

A head injury can happen after a fall, collision, sports impact, car crash, assault, or blow from an object. A strong jolt to the body can also move the brain inside the skull, even when the head does not directly strike anything.

Some head injuries are minor. Others may cause a concussion, skull fracture, bleeding around the brain, spinal injury, or another medical emergency.

A person does not need to lose consciousness to have a concussion or serious brain injury. Symptoms may appear immediately, or they may not become noticeable until several hours or days later.

When a head injury occurs, stop the activity, keep the person still, check for emergency warning signs, and arrange appropriate medical evaluation.

Make Sure the Scene Is Safe

Before approaching, look for dangers such as:

• Traffic
• Falling objects
• Fire
• Electrical wires
• Broken glass
• Violence
• Sports activity continuing nearby
• Unstable stairs or structures

Do not enter an unsafe location. Call 911 and wait for trained responders when necessary.

If the person is wearing a helmet, do not remove it unless you must access the airway, provide CPR, or follow instructions from an emergency professional.

Check Responsiveness and Breathing

Ask:

“Can you hear me? Are you okay?”

Do not shake the person.

Check whether they are breathing normally. Gasping, snorting, or occasional irregular breaths are not normal breathing.

If the person is unresponsive and not breathing normally:

1. Call 911.
2. Begin CPR.
3. Send someone to get an AED.
4. Use the AED as soon as possible.
5. Minimize unnecessary movement of the head and neck.
6. Follow instructions from the dispatcher.

Protecting the airway and providing CPR are more important than keeping the spine perfectly still when the person is not breathing.

Assume a Neck or Spinal Injury May Be Present

A force strong enough to injure the head may also injure the neck or spine.

Tell the person:

“Please stay still. Help is coming.”

Do not:

• Sit them up
• Help them walk
• Twist the neck
• Remove a helmet unnecessarily
• Move them into a vehicle
• Allow them to “shake it off”

Keep the head and neck in the position found. You may place rolled towels or your hands along the sides of the head to discourage movement without forcing the neck into a different position.

Move the person only when they are in immediate danger or when movement is necessary to provide lifesaving care.

Call 911 for Head-Injury Danger Signs

Call 911 or seek immediate emergency care when the person has:

• Loss of consciousness
• Increasing difficulty staying awake
• Inability to wake
• A seizure
• Repeated vomiting
• A headache that becomes worse or does not go away
• Increasing confusion, agitation, or unusual behavior
• Slurred speech
• Weakness or numbness
• Loss of coordination
• Difficulty walking
• One pupil larger than the other
• Double vision
• Blood or clear fluid draining from the nose or ears
• Severe bleeding from the head or face
• A visible skull deformity
• An open or depressed area of the skull
• Bruising behind the ears or around both eyes without a direct eye injury
• Severe neck pain
• Difficulty breathing
• A rapidly worsening condition

Call 911 after a serious mechanism of injury, such as:

• A high-speed vehicle crash
• A fall from a significant height
• Being struck by a vehicle
• A major sports collision
• A penetrating injury
• A crushing accident
• A violent assault

CDC guidance identifies worsening headache, repeated vomiting, seizures, slurred speech, unequal pupils, increasing confusion, weakness, reduced coordination, and inability to wake as emergency danger signs after a head injury. CDC: Symptoms of Mild TBI and Concussion

Control Scalp Bleeding Carefully

Scalp wounds can bleed heavily because the scalp contains many blood vessels.

For an ordinary scalp cut:

• Put on gloves when available.
• Place sterile gauze or a clean cloth over the wound.
• Apply firm, steady pressure.
• Continue until the bleeding stops or responders take over.

Do not apply firm pressure directly over an area when:

• The skull appears dented or deformed.
• Bone is visible.
• An object is embedded.
• The wound appears to involve a skull fracture.

Instead, cover the area loosely and apply pressure around—not directly over—the damaged area.

Do not remove an embedded object.

What Is a Concussion?

A concussion is a type of mild traumatic brain injury. It can temporarily affect thinking, memory, balance, coordination, vision, mood, sleep, and the ability to complete normal activities.

A concussion may result from:

• A direct blow to the head
• A fall
• Whiplash-like movement
• A collision
• A blast or explosion
• A hard hit to the body that causes the brain to move inside the skull

Normal-looking medical imaging does not necessarily rule out a concussion. Concussions are often diagnosed based on the event, symptoms, and examination.

Possible Concussion Symptoms

Physical Symptoms

• Headache
• Pressure in the head
• Dizziness
• Balance problems
• Nausea
• Vomiting
• Blurred vision
• Double vision
• Sensitivity to light
• Sensitivity to noise
• Ringing in the ears
• Tiredness
• Feeling slowed down
• Neck discomfort

Thinking and Memory Symptoms

• Confusion
• Difficulty concentrating
• Trouble remembering
• Feeling mentally foggy
• Slower answers
• Difficulty following instructions
• Forgetting events before or after the injury
• Difficulty completing familiar tasks

Emotional and Behavioral Symptoms

• Irritability
• Anxiety
• Sadness
• Increased emotions
• Restlessness
• Personality changes
• Reduced frustration tolerance

Sleep Symptoms

• Sleeping more than usual
• Sleeping less than usual
• Difficulty falling asleep
• Poor-quality sleep
• Daytime drowsiness

A person may have only one or two symptoms. Symptoms may also change during recovery.

Signs Other People May Notice

Someone observing the injured person may notice:

• A dazed appearance
• Slow responses
• Repeated questions
• Forgetting instructions
• Clumsy movement
• Poor balance
• Unusual behavior
• Mood changes
• Difficulty recognizing people or places
• Loss of consciousness
• Reduced awareness of what happened

The injured person may not recognize or admit that something is wrong. Observations from family members, teammates, coworkers, or witnesses can be important.

Stop Sports and Risky Activities Immediately

Remove an athlete from play whenever a concussion is suspected.

The person should not return:

• Later in the same game
• After a short rest
• Because the headache improved
• After passing an informal sideline test
• Because the team needs them
• Because they insist they feel fine

The CDC recommends removing an athlete from participation immediately and keeping them out for the rest of the day and until a healthcare professional approves their return. CDC HEADS UP: Responding to a Sports-Related Concussion

A second head injury before the brain has recovered may cause more serious harm and prolong recovery.

Arrange Medical Evaluation

A possible concussion should be evaluated by a qualified healthcare professional.

Contact the person’s doctor, urgent care center, or emergency department depending on:

• The force of the injury
• Symptoms
• Age
• Medical history
• Use of blood-thinning medication
• Whether consciousness was lost
• Whether symptoms are worsening
• Whether a neck injury is possible

Do not leave the person alone while arranging care.

Blood-Thinning Medication

A person taking blood-thinning medication may have a greater risk of serious bleeding after a head injury, even when the impact seems minor and the person initially feels well.

Medications may include anticoagulants, antiplatelet drugs, and certain other products affecting clotting.

Seek prompt professional advice after a head injury when the person takes medication that affects bleeding.

Tell the healthcare professional:

• The medication name
• The dosage
• When the last dose was taken
• Why it was prescribed
• Whether the person also takes aspirin or another blood-thinning product

Do not stop a prescribed blood thinner unless the prescribing or emergency professional tells you to do so.

Older Adults

Older adults may experience serious injury after a relatively minor fall. They may also have a lower threshold for bleeding, take blood thinners, or have symptoms mistakenly attributed to aging or dementia.

Look for:

• New confusion
• Unusual sleepiness
• Difficulty walking
• New weakness
• Vomiting
• Headache
• Behavior changes
• A decline in normal functioning
• Bruising around the head or face

Seek medical advice after a head injury in an older adult, especially when they take blood thinners, live alone, cannot clearly describe what happened, or have a noticeable change from their usual condition.

Infants and Young Children

Young children may not be able to describe headache, dizziness, or confusion.

Possible signs include:

• Unusual crying
• Inability to be comforted
• Refusing to nurse or eat
• Vomiting
• Loss of interest in toys or activities
• Changes in sleep
• Unusual irritability
• Unsteady walking
• Reduced speech
• A dazed appearance
• Loss of recently learned skills
• A bulging soft spot on an infant’s head
• Extreme sleepiness

Call 911 or seek emergency care for danger signs. Contact the child’s healthcare professional whenever a concussion may have occurred.

Observe for Changes

Symptoms can appear or worsen after the injury.

Monitor:

• Alertness
• Breathing
• Headache
• Vomiting
• Speech
• Balance
• Vision
• Memory
• Behavior
• Strength
• Coordination
• Pupil appearance

Write down:

• When the injury occurred
• How it happened
• Whether consciousness was lost
• Symptoms and when they appeared
• Any vomiting
• Medication taken
• Changes in behavior or alertness

Provide this information to the healthcare professional.

Can the Person Sleep?

A person with a possible concussion does not automatically need to be kept awake all night.

Sleep is an important part of recovery. However, the person should first be evaluated or receive professional guidance when the injury or symptoms are concerning.

After a healthcare professional determines that home observation is appropriate:

• Follow the discharge instructions.
• Allow normal sleep unless told otherwise.
• Have a responsible adult nearby.
• Ask whether the person should be awakened for checks.
• Know which symptoms require emergency care.

Do not give a sleep aid, sedative, or other medication unless a healthcare professional approves it.

The CDC specifically advises allowing children with concussion to sleep normally rather than intentionally preventing sleep. CDC HEADS UP: Recovery From Concussion

Call 911 if the person becomes unusually difficult to wake.

Medication for Headache

Ask a healthcare professional which pain reliever is safe after a head injury.

Acetaminophen may be recommended in some circumstances. Aspirin, ibuprofen, naproxen, and other anti-inflammatory medications can affect bleeding and may not be appropriate immediately after certain head injuries.

Do not:

• Give medication to someone who cannot swallow safely.
• Give more than the label recommends.
• Combine products containing the same ingredient.
• Use someone else’s prescription.
• Give alcohol or recreational drugs.
• Use medication to hide symptoms so the person can return to sports or work.

Do not stop a necessary prescription medication without professional guidance.

The First Day or Two of Recovery

Follow the healthcare professional’s instructions.

Early recovery may include:

• Relative rest
• Adequate sleep
• Regular meals
• Appropriate hydration
• Limited screen use if it worsens symptoms
• Short, gentle walks
• Reduced school or work demands
• Avoiding alcohol
• Avoiding activities with another head-injury risk

Complete isolation in a dark room and strict bed rest are no longer recommended for most concussions. Too little activity for too long can also make recovery more difficult.

Brief, light physical and mental activity may be appropriate as long as it does not significantly worsen symptoms. Stop or reduce the activity when symptoms increase.

Helpful Resources: Browse Burns & Minor Injuries for products, equipment, services, or supplies related to this section.

Screens, Reading, and Concentration

Phones, computers, television, reading, and detailed tasks may worsen headache, dizziness, eye strain, or concentration problems.

During early recovery:

• Use shorter periods of screen time.
• Reduce brightness.
• Take frequent breaks.
• Avoid rapidly moving images when they cause symptoms.
• Complete one task at a time.
• Stop when symptoms noticeably increase.

Gradually increase activity as tolerated and according to professional guidance.

Returning to School

Many children and teenagers can begin returning to school within a day or two with appropriate support.

Temporary accommodations may include:

• Shortened school days
• Rest breaks
• Reduced homework
• Extra time for assignments or tests
• A quieter workspace
• Reduced screen exposure
• Sunglasses or reduced lighting when appropriate
• Avoiding physical education
• Delayed major examinations

The school nurse, teachers, counselors, and coaches should know that the student is recovering from a concussion.

Return to learning generally occurs before full return to sports.

Returning to Work

An adult may need temporary adjustments such as:

• Shorter shifts
• Additional breaks
• Reduced screen time
• Less lifting
• Reduced noise exposure
• Fewer complex tasks
• Extra time for assignments
• Avoiding heights
• Avoiding machinery
• Avoiding safety-sensitive work
• Working from home when appropriate

Tell the healthcare professional what the job requires. Someone who works with vehicles, machinery, heights, weapons, patients, children, or hazardous materials may need specific clearance.

Driving

Do not drive immediately after a possible concussion.

Concussion can affect:

• Reaction time
• Vision
• Balance
• Attention
• Judgment
• Ability to process information

Ask a healthcare professional when it is safe to return to driving. Consider medication side effects and ongoing symptoms.

Do not ride a bicycle, motorcycle, scooter, or other vehicle while symptoms continue or another fall is possible.

Returning to Sports

Return to sports should be gradual and supervised.

The person should:

• Receive medical clearance.
• Return successfully to regular school, work, and everyday activities.
• Complete a step-by-step increase in physical activity.
• Stop and report symptoms that return.
• Avoid contact, collision, and fall-risk activities until cleared.

Do not skip steps or attempt to hide symptoms.

A helmet can reduce the risk of severe head injury or skull fracture during certain activities, but no helmet can prevent every concussion.

Alcohol and Recreational Drugs

Avoid alcohol and recreational drugs during recovery.

They may:

• Slow recovery
• Worsen symptoms
• Affect balance
• Increase fall risk
• Interfere with sleep
• Hide neurological changes
• Interact with medication
• Increase the chance of another injury

Ask the healthcare professional when alcohol use is considered safe.

Ongoing Symptoms

Most people improve with appropriate care, but some experience symptoms for several weeks or longer.

Contact the healthcare professional when:

• Symptoms are not improving.
• Symptoms become worse after activity.
• Headaches continue.
• Sleep remains disrupted.
• Mood changes persist.
• School or work remains difficult.
• Balance problems continue.
• Memory or concentration does not improve.
• New symptoms appear.

The CDC advises follow-up when symptoms do not resolve within approximately two to three weeks or worsen after returning to regular activities. CDC: What to Do After a Mild TBI or Concussion

Additional support may include physical therapy, vestibular therapy, vision care, headache treatment, school accommodations, mental health care, or evaluation by a concussion specialist.

Emotional Changes

A concussion may temporarily affect emotions and behavior.

The person may feel:

• Irritable
• Anxious
• Sad
• Frustrated
• Isolated
• Easily overwhelmed
• Worried about recovery

Provide reassurance without dismissing the symptoms.

Contact a healthcare professional if emotional changes are severe, worsening, or persistent. Call or text 988 in the United States for a mental health crisis, and call 911 when there is immediate danger.

Preventing Head Injuries

Reduce risk by:

• Wearing seat belts
• Using age-appropriate car seats and booster seats
• Wearing a properly fitted helmet for appropriate activities
• Using handrails
• Improving lighting
• Removing trip hazards
• Following sports safety rules
• Avoiding dangerous play
• Never driving under the influence
• Using fall protection at work
• Addressing balance and vision problems
• Reviewing medications that increase fall risk
• Replacing damaged helmets

A helmet should be replaced according to the manufacturer’s instructions after a significant impact.

Common Mistakes to Avoid

Try not to:

• Shake an unresponsive person.
• Move someone with a possible spinal injury.
• Remove a helmet unnecessarily.
• Apply direct pressure over a suspected skull fracture.
• Leave the person alone.
• Assume no loss of consciousness means no concussion.
• Allow same-day return to sports.
• Encourage the person to “push through” symptoms.
• Keep someone awake all night without medical instructions.
• Confine someone to a dark room for several days.
• Give aspirin or anti-inflammatory medication without checking.
• Allow driving, machinery use, or alcohol during early recovery.
• Ignore symptoms that appear later.
• Dismiss new confusion in an older adult.
• Rush the person’s return to normal activity.

A Simple Head-Injury Checklist

When someone injures their head:

1. Make sure the scene is safe.
2. Check responsiveness and normal breathing.
3. Call 911 and begin CPR if the person is not breathing normally.
4. Keep the head and neck still.
5. Look for emergency danger signs.
6. Control ordinary scalp bleeding with direct pressure.
7. Do not press over a suspected skull fracture.
8. Remove the person from sports and risky activity.
9. Do not leave them alone.
10. Arrange appropriate medical evaluation.
11. Monitor for symptoms that appear or worsen later.
12. Follow professional instructions for sleep, medication, activity, school, work, and driving.
13. Prevent another head injury during recovery.
14. Call 911 if the person develops repeated vomiting, worsening headache, seizure, unequal pupils, weakness, slurred speech, increasing confusion, or difficulty waking.

A head injury may look minor while a more serious problem is developing beneath the surface. When symptoms are concerning, worsening, or difficult to judge, seek professional care rather than waiting for certainty.

Suggested Guides

• First Aid Basics: What Everyone Should Know
• What to Do When Someone Faints
• What to Do When Someone Has a Seizure
• What to Do After a Fall
• Handling Sprains, Strains & Possible Broken Bones
• Choosing Between Your Doctor, Urgent Care & the Emergency Room

Important Health & Safety Notice

The information in this guide is provided for general educational purposes only. Independence Answers is not a medical provider, and this content is not a substitute for professional medical advice, diagnosis, treatment, or supervision. Always follow the instructions of your doctor, pharmacist, or other qualified healthcare professional, especially if you have a medical condition, take medication, or are unsure whether an action is safe for you.

Do not ignore or delay seeking professional care because of something you read here. If you believe someone may be experiencing a serious or life-threatening emergency, call 911 or your local emergency number immediately.