A closed head injury is
to the head that causes the skull and brain to knock or shake. Internal damage can occur to the:
SkullBrainBlood vesselsLayers between the skull and scalp
This damage can cause swelling or pressure on the brain. The injury can be throughout the brain and skull or it may confined to 1 area.
Often times, the head injury is minor. However, it can serious and life threatening. It requires care from a doctor.
Closed head injuries are caused by trauma to the head. This is often due to: Accidents (such as automobile, work-related, sports-related)FallsAbuse
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Factors that may increase your chance of a closed head injury include: Advanced age—increased risk of fallsYounger age— increased risk of motor vehicle accidentsHigh-impact sports, such as boxing, basketball, baseball, or footballPhysical abuse, such as shaken baby syndrome
Previous head injury or
Symptoms can appear right away, or the days and weeks following the injury.
Concussion symptoms include: Confusion, loss of memory about the accidentLow-grade headache or neck painNauseaHaving trouble remembering, paying attention, organizing, making decisionsSlowness in thinking, acting, speaking, or readingFeeling fatigued or tiredChange in sleeping pattern, such as sleeping longer or having trouble sleepingLoss of balance or lightheadednessIncreased sensitivity to sounds, light, or distractionsBlurred vision or eyes that tire easilyLoss of sense of taste or smellRinging in the earsFeeling sad, anxious, or listless, lacking motivationBecoming easily irritated or angry for little or no reason
Symptoms of a
or focal brain injury:
Leaking cerebrospinal fluidBlood in the earsWeakness or numbness of the limbsPainSwelling, tenderness at injury siteHeadacheHearing lossProgressive worsening of cognition or level of alertness
Be sure you know which symptoms your doctor needs to know about right away. If you have been evaluated for a closed head injury and your symptoms are getting worse, get medical help right away.
You will be asked about your symptoms and medical history. A physical exam will be done. You may be referred to a neurologist for special testing.
Tests may include: Blood testsNeurological examinationNeuropsychological testsElectroencephalogram
(EEG)—to evaluate electrical activity in the brain
Imaging tests evaluate the brain and other structures: CT scanCT angiographyMRI scan
Imaging tests are not routinely done in children with minor head injuries. Your child may be observed to determine if imaging tests are needed.
Talk with your doctor about the best treatment plan for you. Treatment will depend on: Your symptomsLocation and severity of the injury
Treatment options include the following:
For minor injury with little or no symptoms, your doctor may advise that you watch for symptoms to develop in the days and weeks that follow.
If you have a concussion, a responsible adult will need to observe you. You may also need to limit drug and alcohol use.
You may need more testing. These tests assess how your brain functions. The results can help your doctor determine: How you are recoveringWhether you are ready to return to high-impact activities
You may be referred to a counselor to take part in a rehabilitation program to improve functioning.
Medications can be used to: Reduce painReduce pressure inside the head or brain swellingPrevent seizures (given in some cases)
This usually involves making “burr holes” in the scalp and skull and draining the clotting blood. Sometimes a section of the skull is removed to relieve pressure. This is called a craniotomy.
To help reduce your chance of a closed head injury: Do not drink alcohol and drive.Do not take medications that may make you sleepy, especially when driving or using heavy equipment.Obey speed limits and other driving laws.In vehicles, always use seatbelts, shoulder harnesses, and child safety seats. Only use child safety seats when traveling. Do not use them outside of the vehicle.Learn about the air bags in your car.
Wear a helmet when:
Riding a bike or motorcyclePlaying a contact sport like football, soccer, or hockeyUsing skates, scooters, and skateboardsCatching, batting, or running bases in baseball or softballRiding a horseSkiing or snowboardingWear mouth guards, face guards, pads, and other safety gear while playing sports.Make sure your child's play surface is soft and free of rocks, holes, and debris.
Reduce falling hazards at home for children and adults, by:
Using handrails when walking up and down stairsHaving safety gates by stairs and safety guards by windowsUsing grab bars in the bathroomPlacing non-slip mats in the bathroomKeeping walkways clear to avoid trippingMaking sure rooms and hallways are well-litKeep firearms and bullets locked safely away.
Concussion and mild traumatic brain injury. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed. Updated April 29, 2009. Accessed May 19, 2009.
The management of minor closed head injury in children. Committee on Quality Improvement, American Academy of Pediatrics. Commission on Clinical Policies and Research, American Academy of Family Physicians.
10/5/2010 DynaMed's Systematic Literature Surveillance
http://www.ebscohost.com/dynamed: Parikh SN, Wilson L. Hazardous use of car seats outside the car in the United States, 2003-2007.
4/1/2014 DynaMed's Systematic Literature Surveillance
http://www.ebscohost.com/dynamed: Choosing wisely. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 26, 2014. Accessed April 1, 2014.
5/12/2014 DynaMed's Systematic Literature Surveillance
http://www.ebscohost.com/dynamed: Cantor J, Ashman T, et al. Evaluation of short-term executive plus intervention for executive dysfunction after traumatic brain injury: a randomized controlled trial with minimization. Arch Phys Med Rehabil. 2014;95(1):1-9.
Last reviewed November 2014 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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