Head Injury Instructions

This leaflet is intended for people who have been assessed by a doctor or nurse following a head injury (and for their carers), but who have been allowed home. Always see a doctor or nurse if you are concerned about an injury.

Minor head injury and knocks to the head are common, particularly in children. Following the injury, if the person is awake (conscious), and there is no deep cut or severe head damage, it is unusual for there to be any damage to the brain.

However, sometimes a knock to the head can cause damage to the brain or to a blood vessel next to the brain. A damaged blood vessel may bleed into the brain, or more commonly, into the area between the brain and the skull (a subdural haemorrhage). This is uncommon, but can be serious, as a build-up of clotting blood can cause pressure on the brain. See separate leaflet called Subdural Haematoma for further detail.

Symptoms of damage or bleeding may not develop for some hours, or even days, after a knock to the head. In rare cases, symptoms from a slow bleed can develop even weeks after a head injury.

This is why 'head injury instructions' are given to people who have had a head injury. These provide information, including symptoms to look out for following a knock to the head.

  • Drowsiness when you would normally be wide awake (but see below).
  • The injury was associated with loss of consciousness or penetrating injury to the head.
  • Worsening headache - which does not go away with paracetamol (but see below).
  • Confusion, strange behaviour, and any problems with understanding or speaking.
  • Inability to remember events before or after the head injury.
  • Unresolving headache.
  • Being sick (vomiting).
  • Loss of use of part of the body - for example, weakness in an arm or a leg.
  • Dizziness, loss of balance or walking strangely.
  • Fitting (convulsions) or collapse followed by feeling strange afterwards.
  • Any visual problems, such as blurring of vision or double vision.
  • Blood or clear fluid leaking from the nose or ear.
  • New deafness in one or both ears.
  • Unusual breathing patterns.
  • You have a history of bleeding easily, or are taking medications which thin the blood; or, you have previously had brain surgery.

If none of the above are present, your doctor may still send you to be assessed in accident and emergency. Your doctor will do this if there are any concerns regarding the diagnosis, there is altered behaviour or irritability (particularly in children) or there is no one to be with you for the first 24 hours of the head injury.

A note about drowsiness

After a knock to the head, children will often cry, be distressed and then settle down. It is then quite common for them to want to sleep for a short while. This is normal. However, it will appear to be a normal 'peaceful' sleep, and they wake up fully after a nap.

Some parents are afraid to let their children go to sleep if the accident happens just before bedtime. Do let them. Drowsiness means they cannot be roused. If you have a concern, wake the child up after an hour or so. They may be grumpy about being woken up, but that is reassuring. You can then let him or her go back off to sleep again. You can do this a few times during the night if there is particular concern. When asleep, check to see that he or she appears to be breathing normally and is sleeping in a normal position.

A note about headache

It is normal after a knock to the head to have a mild headache. Sometimes there is also tenderness over bruising or mild swelling of the scalp. Some paracetamol or ibuprofen will help. It is a headache that becomes worse and worse which is of more concern.

Some people develop some mild symptoms after a head injury that are not serious and usually go away within two weeks. These can include:

  • A mild headache
  • Feeling a bit sick without being sick (vomiting)
  • Being irritable and grumpy
  • Tiredness
  • Poor appetite
  • Some difficulty concentrating

These may develop just as a reaction to a knock on the head and not due to bleeding or serious injury. However, if you have any doubt about a symptom following a head injury then it is best to get it checked out by a doctor as soon as possible. Also, see a doctor if you feel that you have not completely recovered after two weeks.

  • Details of the injury and how severe it is.
  • The need for a responsible adult to be with you for the initial 24 hours after their injury.
  • How quickly you can expect to recover and what this is likely to involve. This will include when you can return to work or school. Some patients may develop complications later.
  • Contact details of where to get further help if any complications occur.
  • Available support organisations.
  • Show a relative or friend this advice leaflet so they too know what symptoms to look out for.
  • Stay within easy reach of a telephone and medical help for the following few days.
  • Do not take any alcohol or drugs for the following few days.
  • Do not take sleeping tablets or sedatives unless prescribed by a doctor.
  • Discuss with your doctor about playing contact sports such as rugby or football. It is often advised that you should not play contact sports for three weeks following a head injury.
  • Do not drive, ride a motorbike or bicycle, or operate machinery until you feel completely recovered.

Further help & information

Original Author:
Dr Tim Kenny
Current Version:
Peer Reviewer:
Dr Adrian Bonsall
Last Checked:
13/06/2014
Document ID:
4262 (v42)
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