Head Injury And Concussion

Overview

A head injury is any harm to your head, scalp, skull (the bony part of your head), or brain. A concussion is the most common type of head injury. It happens when a bump, blow, or jolt makes your brain shake inside your skull. The brain is soft and sits in fluid inside a hard bony box. A sudden movement can stretch and twist the brain's nerve cells for a short time. This changes how the brain works for a while. Most people recover fully, but the brain needs time and rest to heal. A concussion is sometimes called a 'mild traumatic brain injury'. 'Mild' refers to the injury at the start, not to how you feel afterwards. Your symptoms can still be very real and upsetting.

Yes. Head injuries are very common. They are one of the most frequent reasons people go to an emergency department or see their doctor. Concussions happen in sport, at home, at work, and on the road. Most are not serious, but they should always be taken seriously.

Anyone can get a head injury at any age. Some groups are more at risk: young children, who fall often and may not be able to explain how they feel; teenagers and young adults, especially those who play contact sports; older adults, who are more likely to fall and bruise or bleed more easily; people taking blood-thinning medicines; people who drink a lot of alcohol; and people who have had a concussion before.

Symptoms

Common symptoms

• Headache, or a feeling of pressure in the head
• Feeling confused, foggy, or 'not quite yourself'
• Dizziness or problems with balance
• Feeling or being sick (nausea or vomiting)
• Problems with memory, such as not remembering the hit or the moments around it
• Trouble concentrating or thinking clearly
• Feeling slowed down, or needing more time to answer
• Sensitivity to light or noise
• Tiredness, or the opposite, trouble falling asleep
• Changes in mood such as feeling irritable, anxious, or tearful
• Blurred vision or 'seeing stars'

Symptoms in children

• Crying more than usual, or being hard to comfort
• Being irritable, grumpy, or easily upset
• Not feeding or eating as usual
• Being more sleepy than usual, or hard to wake
• Being less interested in playing or in favourite toys
• Looking dazed or not responding to you normally
• Vomiting, or complaining of a headache if old enough to say so
• Changes in sleep, or trouble settling
• Problems with walking, talking, or balance
• A bump or bruise on the head, though a visible bump does not always mean a serious injury

Symptoms in older adults

• Confusion or memory problems that are new or worse than usual
• A new headache, or one that keeps getting worse
• Feeling dizzy, unsteady, or more prone to falls
• Changes in behaviour, such as being unusually quiet or agitated
• Sleeping much more than usual, or being hard to wake
• Symptoms after a fall that may not have seemed serious at the time
• Higher risk of bleeding inside the head, especially if you take blood thinners
• Symptoms that appear hours or even a day or two after the knock

Causes

Main causes

• Falls, especially at home, on stairs, or in the bath or shower
• A direct blow to the head, such as during sport or a fight
• A jolt to the body that snaps the head back and forth, such as in a car crash
• Hitting your head on a door, cupboard, low ceiling, or piece of furniture
• Being knocked over or tripping while walking, running, or cycling
• Workplace accidents, such as things falling from height
• Shaking injuries, which are very serious and can happen to babies and young children

Risk factors

• Having had a concussion before, especially if you went back to sport or activity too soon
• Playing contact sports such as rugby, football, boxing, or martial arts
• Not wearing a helmet when cycling, skating, skiing, or riding a motorbike
• Not wearing a seatbelt in a car
• Being an older adult, because falls are more common and the brain bleeds more easily
• Being a young child, because falls happen often and children may not describe symptoms
• Taking blood-thinning medicine or having a bleeding disorder
• Drinking a lot of alcohol or using drugs, which raise the chance of falls and make symptoms harder to notice
• Having problems with balance, vision, or walking
• Living alone, which can mean help is slower to arrive after a fall

When to see a doctor

See a doctor urgently if:

• You or someone else was knocked out, even briefly
• Symptoms are getting worse instead of better
• Vomiting, a severe headache, or confusion after a knock to the head
• A head injury in a baby, young child, or older adult
• A head injury while taking blood thinners
• You cannot remember what happened, or have gaps in your memory
• You feel unsteady on your feet or have new vision problems
• Any weakness, numbness, or trouble speaking

Book a routine appointment if:

• Symptoms such as headache, tiredness, or poor concentration are still there after a week or two
• You are finding it hard to return to work, study, or sport
• You feel low, anxious, or not yourself after the injury
• You want advice on when it is safe to drive, play sport, or go back to work
• You keep getting headaches or dizziness weeks after the injury
• You are not sure whether your symptoms are normal

Diagnosis

A doctor or nurse will talk to you or the person who saw the injury happen. They will ask what happened, whether you were knocked out, and how you feel now. They will check your memory, balance, and thinking. They will also do a physical check, including your eyes, strength, sensation, and walking. They will ask about any blood thinners, health conditions, and alcohol or drug use. In many cases, this is enough and no scan is needed. A scan is only done if there are warning signs, such as being knocked out, repeated vomiting, a severe headache, a seizure, or a skull fracture. A scan shows bleeding or a break in the bone, but it does not show a concussion itself.

Tests that may be done

• Questions about what happened and whether you lost consciousness or have memory gaps
• A physical and neurological examination, checking your pupils, strength, sensation, balance, and walking
• Questions about your symptoms, sleep, mood, and ability to concentrate
• A simple check of memory and attention, such as remembering words or numbers
• A CT scan of the head, using X-rays, if there are warning signs of bleeding or a skull fracture
• An MRI scan in rare cases, for example if symptoms do not settle or a more detailed picture is needed
• Tests of balance or eye movements, sometimes done in a specialist clinic

What to expect at your appointment

Most visits are quick and do not involve a scan. The doctor will explain what to watch for, give advice on rest and a slow return to normal life, and tell you when to come back. You may be given a written symptom checklist to fill in over the next few days. If you are sent for a CT scan, it is usually done the same day and is painless. You may need someone to stay with you for the first 24 hours. This is normal advice, not a sign that something is seriously wrong. If you play sport, you may be told not to play again until you have been checked and cleared.

Treatment

The main treatment for a concussion is time. The brain needs rest from hard thinking and physical effort, but not total quiet in a dark room for days. Current advice is to rest for the first day or two, then slowly add gentle activity as you feel able. Doing a little more each day, without pushing through worse symptoms, helps most people recover faster. Your doctor will check you, give advice on what to avoid, and tell you when to come back. They may refer you to a specialist concussion clinic if symptoms last more than a few weeks.

Self-care at home

• Rest for the first day or two, then gently return to light daily tasks
• Get plenty of sleep, and keep regular sleep and wake times
• Take breaks from screens, reading, and loud places when symptoms rise
• Write things down or use reminders if memory feels foggy
• Drink water regularly and eat normal meals
• Avoid alcohol and recreational drugs until you are fully better
• Do not drive until your doctor or nurse says it is safe
• Avoid contact sport and any risk of another knock until you are fully recovered and cleared
• Ask your pharmacist or doctor about a simple pain reliever that is safe for you, and follow their advice
• Tell someone at home what to watch for, and ask them to check on you
• Return to work, study, or sport in small steps, and stop if symptoms get worse

Medical treatments

There is no medicine that cures a concussion. Treatment is focused on checking for anything serious, managing symptoms, and guiding a safe return to normal life. Your doctor will check your symptoms and watch for warning signs. They may give advice on simple pain relief and sleep. If symptoms such as headaches, neck pain, dizziness, or balance problems continue, you may be referred to a physiotherapist or a specialist concussion service. Some people benefit from a planned return to work or school, and from support with thinking and memory. If you are an athlete, you may follow a step-by-step return-to-sport plan, checked by a healthcare professional. Any decision about medicine, including over-the-counter pain relief, should be discussed with your pharmacist or doctor.

When is surgery considered?

Surgery is rarely needed for a head injury. It may be needed if a scan shows bleeding inside the head or a broken skull that is pressing on the brain. These are serious injuries that are usually found in hospital after a major blow or fall. Most people with a concussion never need surgery or a hospital stay.

Living with this condition

In the first days and weeks, your energy and thinking may not be at their usual level. This can be frustrating. Plan shorter days, take breaks between tasks, and avoid doing several things at once. Keep a simple routine for sleep, meals, and light activity. Notice what makes symptoms worse, such as long screen time, busy shops, or loud music, and take a short break when they rise. Build up slowly. If you go back to work or school, ask about going part-time or having rest breaks at first. Most people improve week by week.

Lifestyle tips

• Keep a regular sleep routine and aim for enough sleep each night
• Start with light activity such as short walks, and build up slowly
• Avoid alcohol until you are fully recovered
• Limit long periods of screen time and take frequent breaks
• Avoid noisy, busy, or brightly lit places if they make symptoms worse
• Eat regular meals and drink water through the day
• Avoid contact sport and activities where another knock is likely until you are cleared
• Keep important appointments and write down questions before you go
• Tell family, friends, or colleagues what you are finding hard so they can help

Diet and exercise

There is no special diet for concussion, but eating regular, balanced meals and drinking enough water supports recovery. Alcohol is best avoided until you feel fully well, as it can worsen headaches, sleep, and thinking. Gentle exercise helps. Short walks and light daily activity are good once the first day or two has passed. Build up slowly. If symptoms get worse during or after activity, ease off and try a little less the next day. Hard exercise, heavy lifting, and contact sport should wait until you are recovered and cleared by a healthcare professional. A physiotherapist can help if you have neck pain or balance problems.

Mental health and emotional wellbeing

It is very common to feel worried, low, irritable, or frustrated after a head injury. Your brain is healing, sleep may be disturbed, and everyday tasks may feel harder. This can be upsetting, especially if you are used to being busy. These feelings usually ease as you recover. Talk to someone you trust, and tell your doctor if your mood stays low, if you feel very anxious, or if you are not coping. You do not have to manage alone. If you ever have thoughts of harming yourself, please contact your local emergency number or a crisis support service right away, or ask someone to stay with you and help you get help.

Prevention

Many head injuries can be prevented, though not all. Small changes make a real difference.

Screening programmes

There is no routine screening test for concussion. The best approach is to know the warning signs, get checked after a knock to the head, and follow advice before returning to sport or risky activity. If you have had a concussion before, your doctor can advise on how to lower the chance of another one.

Complications

If left untreated

• Symptoms lasting longer than expected, sometimes called post-concussion syndrome: ongoing headaches, dizziness, tiredness, and poor concentration
• Trouble returning to work, study, or sport for a while
• Low mood, anxiety, or sleep problems
• A higher chance of another concussion if you go back to risky activity too soon
• Rarely, serious bleeding inside the head, especially in people taking blood thinners or after a heavy blow
• Very rarely, a second head injury before the first has healed can cause serious swelling of the brain
• Repeated head injuries over years have been linked with long-term problems with memory and mood, which is why prevention and full recovery matter

Long-term outlook

The outlook is good for most people. Most adults and children feel back to normal within a few days to a few weeks. Some people take longer, and that can be frustrating, but it is not unusual. Getting checked, resting at first, then building activity up slowly, and following advice about returning to sport and work all help recovery. If symptoms go on, specialist help is available. With the right support, most people get back to the things they enjoy. Seek medical advice early, and go back to your doctor if you are not improving, so they can help.

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