Ask Your Family Doctor

Developed by the College of Family Physicians of Canada

What are the main causes of head injuries?

A serious head injury is most likely to happen to someone who is in a car accident and isn't wearing a seat belt. Other major causes of head injuries include bicycle accidents, in-line skating (rollerblading) accidents, falls from windows, falls from shopping carts, walkers, throw rugs, falls around the house (especially among toddlers and the elderly), and sports injuries. Another cause in babies is being shaken by an adult.


Are head injuries serious?

They can be. Bleeding, tearing of tissues and brain swelling can occur when the brain moves inside the skull at the time of an impact. But most people recover from head injuries and have no lasting effects.

How can I prevent head injuries?

The most important way to prevent head injuries is by always wearing a helmet during activities that make head injuries more likely. This includes roller blading, bike riding, horse back riding, contact sports and heavy construction work.

How can my doctor tell how bad the damage is?

Your doctor will want to know how the injury occurred, about past medical problems, and about vomiting, seizures (fits) or problems breathing after the injury.
The person who has been more seriously injured may need to stay in the hospital to be watched. Sometimes, special (x-rays)of the brain may be needed to find out more about the damage.

Types of head injuries

A concussion is a jarring injury to the brain. A person does NOT have to pass out to have a concussion as is commonly thought. They may feel dazed or confused. Concussions can be serious and may require a child to be temporarily removed from a sport if it happens repeatedly or is of a sufficient grade to warrant close monitoring.

A brain contusion is a bruise of the brain. This means there is some bleeding in the brain, causing swelling. A contusion is a more serious injury than a concussion.

A skull fracture is when the skull cracks. A skull fracture is often a more serious injury. Sometimes the edges of broken skull bones cut into the brain and cause bleeding or other injury. This is most likely if the skull is broken by something sharp or pointed. Skull fractures are more common in adults than in young children because skulls of young children are softer and "give" more without breaking.

A hematoma is when a head injury causes bleeding in the brain and the blood collects and clots. Sometimes a hematoma may not be apparent for a day or even as long as several weeks after the head injury. This is why it's important to tell your doctor about anything unusual in how the person with the head injury is feeling or behaving. Even a minor head injury can sometimes cause a hematoma, especially in an older person.

What happens after the injury?

It's common to have a mild headache, and feel dizzy and nauseous right after a head injury. Other symptoms include ringing in the ears, neck pain, and feeling anxious, upset, irritable, depressed or tired. The person who has had a head injury may also have problems concentrating, remembering things, putting thoughts together or doing more than one thing at a time. These symptoms usually go away in less than a few weeks, but may go on for over a year if the injury was severe.

Will the head injury cause permanent brain damage?

This depends on how bad the injury was and how much damage it did. Most head injuries don't cause permanent damage. However, even mild head injuries can produce long-term symptoms in some people. See your doctor if symptoms persist.

Will memory be lost?

It's common for someone who's had a head injury to forget the events right before, during and right after the accident. Memory of these events may never come back. Following recovery, the ability to learn and remember new things almost always returns. In sports, it is very important that people with memory loss be carefully evaluated and not return to their sport for at least one week after symptoms are gone.

Will the injury cause epilepsy?

Sometimes epilepsy can start after a head injury. This is much more common if the injury was from something that went through the skull, such as from a gunshot or knife wound. Your doctor might prescribe medicine to lessen the likelihood of epilepsy if he or she thinks the risk is high.

Get help if you notice

	Any symptom that is getting worse, such as headaches, nausea or sleepiness
	Nausea that doesn't go away
	Changes in behaviour, such as irritability, confusion
	Dilated pupils (pupils that are bigger than normal) or pupils of different sizes, blurred vision
	Trouble walking or talking
	Drainage of bloody or clear fluid from ears or nose
	Vomiting
	Seizures/"fits"
	Weakness or numbness in the arms or legs

Is it true that the person must be kept awake after the injury?

No. If your doctor thinks the person needs to be watched this closely, your doctor will probably want to keep the person in the hospital.
Sometimes, doctors will send someone who has had a head injury home if the person with them is reliable enough to watch the injured person closely. In this case, your doctor may ask you to wake the person frequently and ask questions such as "what's your name?" and "where are you?" to make sure everything is okay.

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Revised 2007 The College of Family Physicians of Canada

This information provides a general overview on this topic and may not apply to everyone. To find out if this information applies to you and to get more information on this subject, talk to your family doctor. This health education material has been favorably reviewed by the Patient Education Review Committee of the College of Family Physicians of Canada: Dr Cathy MacLean, Halifax, NS (Scientific Editor) Dr C. Richard Fischer, Pickering, ON Dr Patrice Laplante, Fleurimont, QC Dr Richard Moffatt, Red Deer, AB Dr David Nunn, Kentville, NS Dr Cornelius Woelk, Winkler, MB The College of Family Physicians of Canada, one of the nation's largest medical groups, is committed to promoting and maintaining high standards for family physicians - the doctors who provide ongoing, comprehensive care for people of all ages. This patient education information was developed by The College of Family Physicians of Canada in cooperation with the American Academy of Family Physicians.

Support for this program has been provided by an educational grant to the Research and Education Foundation by Scotiabank.