Should You Go to the Emergency Room After a Mild Head Injury?

You just banged your head fairly hard – perhaps on a kitchen cupboard or that low, pesky doorframe in your basement. As a result, your head hurts, and you already feel a bump forming. But does your injury warrant a visit to the emergency room?

“Not every bump on the head requires emergency medical attention,” says University Hospitals neuropsychologist Christopher Bailey, PhD “However, if you have symptoms of concussion, you should seek medical care.”

What Is a Concussion?

Also known as a mild traumatic brain injury, a concussion occurs when a bump, blow or jolt to the head or body causes the brain to move inside the skull. A concussion can affect normal brain function and lead to a number of physical, cognitive and emotional symptoms.

When to Visit the Emergency Room

Anyone who has just sustained an impact to the head should immediately seek emergency medical care by calling 911 or visiting an emergency room if they experience any of the following symptoms:

• Loss of consciousness
• Inability to recognize people or places
• Trouble with balance or walking
• Repeated episodes of vomiting or nausea
• A worsening headache
• Sudden change in vision
• Unusual behavior or confusion
• Slurred speech or trouble speaking
• Difficulty falling asleep or waking up
• Uncontrollable drowsiness at inappropriate times
• Any seizure activity – uncontrollable shaking of the arms and/or legs
• Numbness or weakness of the arms and/or legs
• Thoughts of hurting yourself or others

Also, a person who sustains an impact to the head at a high speed – for example, in a car accident or as a result of a steep fall – should seek immediate medical attention regardless of their symptoms.

Dr. Bailey cautions that the signs and symptoms of a concussion may not be immediately obvious. Also, concussion symptoms that may be hardly noticeable at first can worsen over time. For these reasons, it is important to monitor your condition, particularly in the 48 hours immediately following a head injury. Other symptoms to watch for during this period of monitoring include:

• Discharge of clear fluid or blood from the nose or ears
• Signs of disorientation or memory loss

Very few cases of concussion (4% to 6%) are associated with any observable changes to the brain that a doctor can see using common neuroimaging technologies such as computerized axial tomography (CT scan) or magnetic resonance imagery (MRI). Symptoms are instead related to changes in brain function rather than any large-scale changes in brain structure that are detectable using neuroimaging.

“Even a ‘mild’ concussion needs medical attention, though it may not require an ER trip,” says Dr. Bailey. If a person who has just sustained a mild head injury does not experience any of the symptoms listed above, treatment of the injury can usually be handled on an outpatient basis with a call to a primary care physician, pediatrician or concussion specialist.

When Can a Bump on the Head Be Worse Than a Concussion?

In rare cases, what initially appears to be a light or mild head injury may actually be a more severe injury that can lead to serious complications and long-term health issues. These types of head injuries include:

• Contusion: A contusion is a bruise on the brain that can cause bleeding and/or swelling.
• Intracranial hematoma (ICH): An ICH is when bleeding under the skull causes a blood clot to form on or in the brain.
• Skull fracture: Sometimes, a fractured skull bone can cut into the brain and cause bleeding and other serious complications.

When in doubt about the severity of your head injury or the head injury of a friend or family member, always err on the side of caution and seek emergency medical treatment right away.

Rest & Recovery

“In almost all cases,” says Dr. Bailey, “a concussion will resolve on its own with some initial rest followed by a progressive return to normal activity – school, work, exercise, etc. – but the time needed to recover can vary greatly from one person to the next. Your doctor or concussion specialist will help you determine what activities to avoid in order to recover the fastest and when you can return back to normal activity.”

Though it can be a frightening experience for patients and families, it is important to remember that nearly everyone recovers from a concussion, especially when they are working with their doctor or concussion specialist. Most of the time, the question is more about when will they recover, not whether they will recover.

Christopher Bailey, PhD is a neuropsychologist at University Hospitals Cleveland Medical Center. You can request an appointment with Dr. Bailey or any other University Hospitals doctor online.