Head injury

Introduction

Head injury refers to any blow or impact to the head, whether it is a simple minor bump or a severe trauma. It is very common in medical practice, especially in emergency rooms. We distinguish between mild (concussion, brief or no loss of consciousness), moderate, and severe injuries depending on the Glasgow score. The main causes are falls (elderly people, children), road accidents, sports injuries, and assaults. Severity is not judged solely on initial appearance: some intracranial bleeding manifests later.

If you or a loved one have just suffered a blow to the head, contact your primary care physician first. If they are unavailable, Docadom offers an emergency consultation by a doctor at home: call 021 845 45 45 or use our application available on the App Store and Google Play. In the event of loss of consciousness, vomiting, or neurological signs, call 144 immediately.

Who is at risk?

Head injuries can affect everyone. The most at-risk profiles are children (falls), the elderly (falls at home, balance disorders, anticoagulant medications), athletes (rugby, hockey, cycling, skiing, combat sports), and victims of road accidents. Patients on anticoagulants or antiplatelet agents have an increased risk of intracranial hematoma, even after an apparently benign impact. Alcohol or drug consumption increases the risk and complicates clinical evaluation.

Symptoms of head injury

Mild head injury

• Moderate headaches, which improve within a few hours.

• Isolated nausea, sometimes a single episode of vomiting.

• Transient dizziness.

• Brief sensation of floating or confusion.

• Brief amnesia of events.

• Preserved state of consciousness.

Warning signs (potentially serious trauma)

• Initial loss of consciousness, even brief.

• Repeated vomiting (≥ 2 times).

• Persistent or gradually worsening headaches.

• Confusion, drowsiness, behavioral changes.

• Seizures.

• Prolonged amnesia of the events or of the hours that followed.

• Neurological deficit: paralysis, speech difficulties, visual disturbances.

• Asymmetrical or non-reactive pupils.

• Bleeding from the nose or ears, raccoon eyes (bruising around the eyes) or bruising behind the ears (skull base fracture).

• Suspicion of associated cervical spine injury.

• Trauma occurring in a patient on anticoagulants or antiplatelet agents.

When to consult in emergency?

Any head injury with warning signs requires an immediate call to 144:

• Loss of consciousness, even brief.

• Repeated vomiting.

• Confusion, drowsiness, behavioral changes.

• Intense or progressive headaches.

• Seizures, neurological deficit.

• Bleeding from the nose or ears.

• Trauma in a child under 2 years old (signs can support misleading interpretations).

• Trauma in an elderly person.

• Trauma in a patient on anticoagulants.

• Suspicion of abuse.

• High-energy mechanism (fall from height, road accident).

What to do before help arrives? Do not move the victim if a cervical injury is possible. Monitor consciousness and breathing. If you call Docadom at 021 845 45 45 or use our smartphone application (App Store and Google Play), details the circumstances and symptoms precisely — the doctor will be able to confirm whether immediate reference to hospital emergencies and a brain scan is necessary. For obviously severe injuries, dial 144 directly.

Causes of head injury

Main circumstances

• Falls: first cause, especially in infants, children, and the elderly.

• Road accidents: car, two-wheelers, pedestrian.

• Sports injuries: skiing, cycling, contact sports, horse riding.

• Assaults, domestic accidents, occupational accidents.

• Abuse to be considered in children.

Types of intracranial lesions

• Concussion: the mildest form, with no structural lesion visible on imaging.

• Cerebral contusion: focal lesion of the parenchyma.

• Extradural hematoma: neurosurgical emergency, rapid progression.

• Acute or chronic subdural hematoma: common in the elderly, sometimes after a minor impact.

• Subarachnoid hemorrhage.

• Diffuse axonal injury in severe trauma.

• Skull fracture with or without depression.

Diagnosis of head injury

Diagnostic methods

• Anamnesis: mechanism, loss of consciousness, amnesia, medical history, treatments (anticoagulants).

• Clinical examination: Glasgow score, complete neurological examination (motor skills, sensitivity, reflexes, pupils), search for fracture, palpation of the cervical spine.

• Glasgow Score: evaluates the state of consciousness (from 3 to 15). Score < 13: moderate to severe trauma.

• CT scan skull without contrast: reference test to screen for hemorrhage, contusion, or fracture. Indicated in case of warning signs.

• Brain MRI: useful as a complement or subsequently.

• Cervical spine imaging in case of suspected associated injury.

• SCAT score in athletes to evaluate a concussion.

Alternative diagnoses

• Fainting that caused the fall, to be differentiated (syncope, arrhythmia, hypoglycemia, stroke).

• Intoxication (alcohol, drugs, medication) which can mimic or worsen signs.

• Post-traumatic migraine or benign headache.

• Benign paroxysmal positional vertigo without injury.

Management and treatment

Mild head injury

Most patients can return home after examination, following written monitoring instructions:

• Physical and cognitive rest (limiting screens, intellectual work).

• Monitoring by a relative for 24 to 48 hours.

• Reconsult immediately if warning signs appear.

• Gradual resumption of activities, including sports.

• Painkillers: paracetamol (avoid aspirin and NSAIDs).

Moderate or severe head injury

Hospital management in intensive care or neurosurgery. Measures: protection of airways, control of blood pressure, fight against intracranial hypertension, treatment of seizures, sometimes emergency surgery (evacuation of a hematoma, drainage). Post-hospital neurological rehabilitation is often necessary.

Special cases

• Patients on anticoagulants: systematic CT scan, prolonged monitoring.

• Children: careful monitoring, using PECARN score to decide on a CT scan.

• Athletes: specific protocols for returning to sport after a concussion.

Prevention of head injury

• Systematic wearing of a helmet: cycling, skiing, horse riding, motorcycling, construction site.

• Wearing a seatbelt.

• Adapting the home for elderly people: lighting, non-slip floors, securing carpets, grab bars.

• Prevention of falls: balance, physical exercise, corrected vision, osteopathy if necessary.

• Securing cribs and stairs for children.

• Avoiding driving under the influence of alcohol or drugs.

• Respecting return-to-sport protocols after a concussion.

• Vigilance when taking anticoagulants or antiplatelet agents.

Possible complications

Complications depend on the severity of the trauma. Mild forms can progress to a post-concussion syndrome (headaches, dizziness, fatigue, sleep disturbances, irritability, cognitive disorders). Severe trauma can lead to permanent neurological sequelae (motor deficits, cognitive disorders, post-traumatic epilepsy, behavioral issues), chronic subdural hematoma, psychiatric disorders (depression, anxiety, post-traumatic stress disorder) and, in the most severe cases, death. Repeated concussions (athletes) expose to the risk of chronic traumatic encephalopathy.

When to contact a doctor for a head injury

Anyone who has suffered a blow to the head deserves medical evaluation. Here is what to do:

• Primary care: if the impact seems minor and there are no warning signs, contact your primary care physician for advice.

• If your primary care physician is unavailable (evening, weekend, holidays), Docadom offers an emergency consultation by a doctor at home. Call 021 845 45 45 or make your request via our mobile application, available for free on the App Store and Google Play.

• In case of severity signs (loss of consciousness, repeated vomiting, confusion, neurological deficit, trauma while on anticoagulants), dial 144 without delay. A brain scan is often essential.

Conclusion: never underestimate a blow to the head

Head injury is very common and most often benign, but it can reveal serious intracranial lesions whose progression can be rapid or delayed. It is characterized by headaches, nausea, amnesia, or loss of consciousness, which can lead to complications such as intracranial hematoma, post-concussion syndrome, or lasting neurological sequelae. Careful monitoring within 24 to 48 hours, recognition of warning signs, and prompt referral to a doctor are essential. Prevention relies above all on wearing a helmet and safety in everyday life.

After a blow to the head, first contact your primary care physician. If they are not available, Docadom provides you with an emergency doctor at home 7 days a week: call 021 845 45 45 or use our mobile application (App Store, Google Play) to request an emergency consultation. If there are warning signs, do not hesitate: 144.