The National Institute for Health and Clinical Excellence (NICE) defines a head injury as any trauma to the head other than shallow injuries on the surface of the face.

For most people, a head injury is usually minor and will not result in any permanent damage. The symptoms are usually mild and short lived.

A minor head injury may cause:

• a bump or bruise on the head
• nausea (feeling sick)
• dizziness

Glasgow Coma Scale

Head injuries are assessed by healthcare professionals using the Glasgow Coma Scale (GCS, see below). This is a scale from 3 to 15 that healthcare professionals use to identify the seriousness of a head injury and how severely the brain has been damaged.

A score of 15 means that there is likely to be little or no damage to the brain. A score lower than 15 means that there may be some degree of damage. The lowest possible score is 3, which means that someone is unconscious and cannot respond at all.

According to the GCS, a head injury is minor if the score is 13, 14 or 15. However, even a minor head injury can require treatment in hospital.

If there is any change to a person’s level of consciousness, for example if they seem confused or cannot remember the accident, this should be treated as a severe head injury. For more information, see Severe head injury.

How common are head injuries?

Each year in England and Wales, around 700,000 people attend accident and emergency (A&E) departments with a head injury. Of these, 90% have only a minor head injury.

The most common causes of head injuries are falls, assaults and road traffic accidents. In the UK, 40-50% of people with head injuries are children. Children may be more likely to have a minor head injury because they have high energy levels and little sense of danger.

Outlook

Minor head injures should not require treatment. However, the person with the injury should be monitored for 48 hours to check for any changes in their condition. 

Serious complications from a minor head injury are rare. One study of 200,000 children in England found that only 14 with minor head injuries required neurosurgery (surgery on the bran, spinal cord or nerves).

Other possible complications include long-term headaches, memory loss or difficulty concentrating. One large study that was carried out in the UK found that approximately one in seven people may still experience these symptoms six weeks after a minor head injury.

The rate of death after a head injury is 0.2%. This means that for every 1,000 people who attend an emergency department at a hospital with a head injury, two of them may die. However, most of these deaths are among people with a moderate or severe head injury, rather than a minor head injury.   

If you have a head injury, it could affect your ability to drive. It is your legal obligation to inform the Driver and Vehicle Licensing Agency (DVLA) about any medical condition that could have an impact on your driving ability. Go to the Directgov website to find out how to tell the DVLA about a medical condition.

A minor head injury often causes a bump or bruise on the exterior of the head. Other symptoms may include:

• nausea (feeling sick)
• mild headache
• tender bruising or mild swelling of the scalp
• mild dizziness

If you or your child experience these mild symptoms after a knock, bump or blow to the head, you do not require any specific treatment.

Close observation

If your child has sustained a head injury, observe them closely for 48 hours to monitor whether their symptoms change or worsen. If you have sustained a head injury, ask a friend or family member to stay with you for the following 48 hours to keep an eye on you.

If your child has a minor head injury, they may cry or be distressed. This is normal and, with attention and reassurance, most children will settle down. However, seek medical assistance if your child continues to be distressed.

Serious symptoms

If, following a knock to the head, you notice any of the symptoms below in either you or your child, seek immediate medical assistance:

• unconsciousness (either very briefly or for a longer period of time)
• difficulty staying awake or still being sleepy several hours after the injury
• having a seizure or fit (when your body suddenly moves uncontrollably)
• difficulty speaking, such as slurred speech
• vision problems or double vision
• difficulty understanding what people say
• reading or writing problems
• balance problems or difficulty walking
• loss of power in part of the body, such as weakness in an arm or leg
• pins and needles (a prickling or burning feeling) in the hands or feet
• amnesia (memory loss), such as not being able to remember what happened before or after the injury
• clear fluid leaking from the nose or ears (this could be cerebrospinal fluid, which normally surrounds the brain)
• a black eye (with no other damage around the eye)
• bleeding from one or both ears
• new deafness (loss of hearing) in one or both ears
• bruising behind one or both ears
• a lasting headache since the injury 
• vomiting since the injury
• irritability or unusual behaviour
• visible trauma (damage) to the head, such as an open, bleeding wound 

If any of these symptoms are present, particularly a loss of consciousness (even for a short period of time), immediately go to the accident and emergency (A&E) department of your local hospital or call 999 and ask for an ambulance.

Causes of minor head injuries in young people and adults include:

• accidents at home
• sports-related injuries
• industrial accidents (such as falls while at work)
• assaults
• road traffic accidents

Causes in children

Children are very active and often have little sense of danger, which is why most children will have some kind of head injury while they are growing up. Some of the more common ways that children may experience a head injury include falls from:

• cots
• windows
• stairs
• trees
• playground equipment

Childhood head injuries may also occur as a result of cycling accidents or road traffic accidents.

Facts

In the UK:

• around three-quarters of people with head injuries are male
• up to one-fifth of people with head injuries are 65 years of age or over
• nearly half of people with head injuries are children
• nearly two-thirds of head injuries in adults involve alcohol

As long as your head injury is minor (see below) and complications are unlikely, you should not need to visit your GP or hospital for treatment. See Symptoms of minor head injury for the serious symptoms of a head injury that will require hospital treatment.

If you are concerned about your or your child’s head injury, see your GP. Otherwise, follow the advice below.

Advice for adults

If you have a minor head injury:

• do not be by yourself for the first 48 hours after the injury
• have plenty of rest
• avoid stressful situations
• do not drink alcohol
• do not take sleeping pills, sedatives or tranquilizers (unless they are prescribed by your doctor)
• do not take aspirin (unless it is prescribed by your doctor)
• take painkillers, such as paracetamol, if you have a headache (always follow the manufacturer’s instructions)
• do not play any contact sport, such as football or rugby, for at least three weeks, and speak to your doctor before you start playing again
• do not return to work, college or school until you have completely recovered and feel ready 
• do not drive a car, motorbike or bicycle or operate machinery until you have completely recovered

Go to a hospital accident and emergency (A&E) department if:

• you lose consciousness or become confused, for example not knowing where you are
• clear fluid leaks from your ear or nose
• you are drowsy (sleepy) when you would usually be awake
• you have problems speaking or understanding other people 
• you lose your balance or have difficultly walking
• you lose power in part of the body, such as weakness in an arm or leg
• you develop a new problem with your eyesight
• you have a headache that keeps getting worse
• you have been sick 
• you have a seizure (fit), when your body suddenly moves uncontrollably

Advice for children

If your child has a minor head injury:

• give them painkillers, such as paracetamol, if they have a mild headache (always read the manufacturer’s instructions and never give aspirin to children under 16 years of age)
• only give them light meals for the first one or two days
• avoid getting them too excited
• do not have too many visitors when they return home
• do not let them play contact sports, such as football or rugby
• make sure that they avoid rough play for a few days

Take your child back to the accident and emergency (A&E) department of your local hospital if they:

• are unusually sleepy or you cannot wake them
• have a headache that is getting worse
• are unsteady when they walk
• are repeatedly sick
• have a seizure (fit)
• develop a squint or blurred vision, or they start to see double
• lose consciousness

Go to A&E if your baby has a minor head injury and continues to cry for a long time.

If you have sustained a minor head injury, there is a small risk that complications will develop. For a few days after the injury, be aware of any more serious symptoms developing.

See Symptoms of minor head injury for a list of the symptoms that will require urgent medical attention.

Post-concussional syndrome

Some people may experience long-term symptoms after sustaining a minor head injury. This could be post-concussional syndrome. Symptoms include:

• having trouble looking after yourself
• not being able to work
• a persistent (continuous) headache
• dizziness
• feeling weak
• tinnitus (a perception of noise in one or both ears, or inside the head)
• nausea (feeling sick)
• trouble sleeping and fatigue (extreme tiredness)
• memory problems
• problems understanding other people
• poor concentration

See your GP if you still experience these symptoms a few weeks after sustaining a minor head injury. Your GP may recommend that you reduce your daily activities to a more manageable level and change your sleeping pattern.

The above symptoms usually clear up in around three months but, if necessary, you may need to be referred for further assessment. This could be with a neurologist, who specialises in problems of the nervous system (brain, spinal cord and nerves), or a psychiatrist (a mental health specialist).

For medical advice or a diagnosis, See your GP or call NHS Direct Wales on 0845 46 47.

Many head injuries are the result of accidents that are very difficult to predict or avoid. However, if you have a head injury, you can reduce your risk of developing serious complications.

Safety helmets

Cyclists and motorcyclists can protect their head by wearing a properly fitting safety helmet. British Standard safety helmets are a legal requirement for motorcyclists.

Research commissioned by the Department of Transport found that bicycle helmets ‘should be effective at reducing the risk of head injury’. However, it is difficult to conclusively determine the benefit of cycle helmets because data about road accidents that involve cyclists may not contain all of the relevant information.

For example, in situations where a car is involved it may not always be clear how fast the car was travelling. The data may also not explain where exactly the head injury occurred, which makes it difficult to determine whether a helmet might have prevented the injury.

The National Institute for Health and Clinical Excellence (NICE), the Royal Society for the Prevention of Accidents (RoSPA) and the World Health Organisation (WHO) all support the use of cycle helmets and suggest that they may help to reduce head injuries. NICE is currently in the process of producing guidance about preventing unintentional injuries in children who are under 15 years of age, which recommends promoting the use of cycle helmets. 

As well as wearing a cycle helmet when cycling, you should also make sure that both you and your children:

• use lights and wear reflective clothing when cycling in the dark
• are aware of the dangers of the road and know how to stay safe
• always follow the Highway Code (see Directgov’s online version of the Highway Code)
• check that the bike is in good working order

Safety in the home

Following sensible health and safety guidelines can help prevent accidents in the home. The advice below will help keep your home and garden as safe as possible:

• Keep stairways tidy so that you do not trip over anything.
• Use appropriate safety equipment if you are doing any kind of DIY.
• Do not stand on an unstable chair to change a light bulb. Use a stepladder.
• Clean up any spillages to prevent someone slipping over.
• Follow the manufacturer’s instructions when using weed killer or any other chemical products.

For more information, go to the Royal Society for the Prevention of Accidents website.

Childproofing your home

It is not possible to ‘childproof’ your home completely. However, you can take steps to keep toddlers and young children safe at home. See the video about accident prevention (above) and the advice below.

• Check that windows are lockable and cannot be opened by your child. This is particularly important for the windows in your child's bedroom.
• Move furniture, such as beds, sofas and chairs away from windows to prevent your child climbing up and falling out.
• Make sure that chemicals, such as cleaning products, are out of your child's reach.
• Do not leave hot water unattended, for example a pan of boiling water or a bath.   
• Fit safety gates at the top and bottom of the stairs.

Safety at work

To reduce the risk of sustaining a head injury at work, always follow any necessary health and safety guidelines. For example, you may have to wear a hard hat and safety shoes when working in potentially hazardous areas.

Sport safety

Wear any necessary safety equipment when playing sports, particularly contact sports. Do not play any contact sports after a head injury without first consulting your GP.