Head injury in adults | Wharanga ūpoko

If someone has had a knock to their head, they may have obvious signs of an injury to their head or face such as bleeding and bruising. Other signs of a head injury include: 

• feeling dizzy or light-headed 
• nausea (feeling sick) or vomiting (throwing up) 
• not being able to remember what happened or recent events 
• having a headache, which can be severe 
• being confused 
• leaking blood or watery fluid from their ears or nose
• being unconscious or semi-conscious
• blurred or double vision. 

Anyone who knocks their head (playing sport or in a fight or accident) and gets up straight away, still needs to be closely watched. If they show any of the warning signs in the list below, they should see a healthcare provider immediately. 

Likewise, anyone who is knocked out (is unconscious and can't be woken up, even if only for a minute or so) needs to see a healthcare provider urgently to exclude a skull fracture or serious brain injury.

Call Healthline free on 0800 611 116 if you feel at all uneasy about an injury or are unsure what to do.

Always get a head injury checked by a healthcare provider if it was caused by a hard bang, if it causes loss of consciousness or concussion, or if you’re concerned about any other physical or mental symptoms. 

Warning signs – the following symptoms need immediate medical attention 

• complaints of neck pain  
• increasing confusion or irritability
• repeated vomiting
• seizure (fit) or convulsion  
• blurred or double vision  
• sleep difficulties – being very sleepy or difficult to wake 
• slurred speech  
• strange feelings or a loss of movement down one side of your body 
• leaking blood or fluid from the ears or nose 
• being lightheaded or dizzy 
• fatigue or tiredness 
• visible skull deformity 
• muscle weakness, tingling or burning in arms or legs 
• worsening level of consciousness or alertness 
• severe or increasing headache  
• unusual change in behaviour 
• having difficulty remembering things. 

Injuries to your head should always be treated seriously as there may be damage to your brain. If not treated properly, permanent and, often, preventable brain damage can occur.  

Anyone who is knocked out – that is, they’re unconscious and can't be woken up, even if only for a minute or so – needs to see a healthcare provider urgently to check whether they have a skull fracture or serious brain injury. 

If the head injury is minor with no worrying symptoms, see our self-care tips for caring for someone at home. 

Delayed symptoms after a head injury 

In some cases, signs of injury to the brain may not appear for 24-48 hours after a head injury due to a gradual increase in swelling or bruising around your brain. 

Anyone who knocks their head (eg, playing sport or in a fight or accident) and gets up straight away, still needs to be closely watched. If they show any of the warning signs listed above, they should see a healthcare provider immediately.  

Rarely, you can be well after a head injury but suddenly get worse some hours later due to bleeding inside your skull. Have someone with you for the first 24 hours so they can call for help if this happens. 

Call Healthline free on 0800 611 116 if you feel at all uneasy about an injury or are unsure what to do. 

Head injuries can happen in many different ways, including:

• being hit on the head
• sporting injuries
• car or bike accidents
• falls around the home (especially for toddlers and older people)
• falls from heights
• speed-related blows to the head.
  
  

Older people 

The most common cause of traumatic brain injury in older people is a fall. If you or someone you care for has experienced a fall, see a healthcare provider as soon as possible to check for the possibility of a brain injury. A brain injury can occur even if the fall is minor or not from a great height.  

Find out more about falls and how to prevent them. 

Depending on which medical service you’re first seen by (GP clinic, urgent care clinic or emergency department), a doctor, ambulance paramedic or hospital staff will assess how serious your head injury is.  

You’ll be asked about what caused your injury and how it happened, and what symptoms you experienced. If you aren’t seen straight after your injury, your healthcare provider will also ask about any ongoing symptoms – these could be physical, cognitive (to do with your thinking), behavioural or emotional – and how they’re affecting your day-to-day life. Any video footage of the event itself will be useful to assist with a diagnosis.  

Your healthcare provider will look for signs of injury such as skull fractures and injury to other parts of your body, and they’ll do tests to check your nervous system. These tests will look at things such as your reflexes, coordination, how well you can feel different sensations, and your memory and thinking skills. They'll also assess your level of consciousness using the Glasgow Coma Scale which is based on whether you can open your eyes by yourself, how well you can answer certain questions and how well you can move your body. See the Glasgow Coma Scale(external link). 

Traumatic brain injuries can be mild, moderate or severe depending on how long you’re unconscious for (if at all), your level of consciousness (alertness) after the injury (based on your GCS score), and how long it takes to remember things after your injury. 

Concussion is a type of mild traumatic brain injury. Your healthcare provider may use a concussion screening tool, which is like a questionnaire, to assess you. This can also be used to monitor your improvement over time. 

If you’re with someone who has a head injury:  

• Get medical help straight away if they’re unconscious or have any of the signs listed above. 
• Sit the person down if they’re conscious, but don’t move them if you suspect a neck or back injury. Apply a cold cloth or ice wrapped in a cloth to the site of their injury. 
• If they have a bleeding wound, apply direct firm pressure to the wound to stem the bleeding. Don’t apply pressure if you think they might have a skull fracture. 
• Check the person's airway and breathing. If they become unconscious, but are breathing, there are ways to help them(external link).  

It’s best to get checked by a healthcare provider after any head injury. This is especially important if you have a severe headache, had any loss of consciousness or have a concussion. 

How a head injury is managed will depend on how severe it is. This will be determined by your Glasgow Coma Scale score and whether you have risk factors such as a possible skull fracture, prolonged loss of consciousness or memory loss. You may need to go to the hospital emergency department for further assessment or your healthcare provider may be able to monitor you at the clinic. 

Once you’re able to go home there are things you should do to help your recovery. Read more in the self-care section below. 

Your healthcare provider will also complete ACC forms so that you’re able to get time off work (or reduced duties), compensation payments, and access to concussion treatment if needed. 

Apps reviewed by Healthify

You may find it useful to look at some first aid and emergency apps and pain management, headache and concussion apps.

There are things you can do to reduce the risk of a head injury or concussion including the following: 

• Use safety equipment, such as seat belts, bicycle or motorcycle helmets, and hard hats, during activities that could cause a head injury.
• Always use child safety seats in a car.
• Follow bicycle safety recommendations(external link).
• Don’t drive (or be driven) under the influence of alcohol or drugs.
• Check your risk of a fall(external link) and find out what you can do to reduce the chances of a fall(external link).
• Install window guards and stair gates to prevent children from falling at home.
• Find out about preventing family violence(external link).
• Follow the rules of your sport and limit the number of contact practices for contact and collision sports. 
• Neck strengthening exercises and use of a mouthguard in contact sports may be helpful.

After a head injury, many patients will have minor symptoms that will get better within days, while some will have symptoms that last for weeks. A few people will have symptoms that go on for longer and may require ongoing rehabilitation. 

The more serious your injury, and the greater the length of time with amnesia (memory loss) after your injury, the more likely it is that you’ll have ongoing symptoms. 

You can help speed up your recovery after a mild traumatic brain injury by following the advice in the self-care section above. Read more about the outlook after a concussion. 

Apps reviewed by Healthify

You may find it useful to look at some first aid and emergency apps and pain, headache and concussion apps.