Head Injury

Medically Reviewed by Tyler Wheeler, MD on November 17, 2022
7 min read

Head injuries are damage to the scalp, skull, or brain caused by trauma. When it affects the brain, they’re called  a traumatic brain injury, or TBI. 

To most people, head injuries are considered an acceptable risk when engaging in sports and other types of recreational activities. But they’re dangerous. They can lead to permanent disability, mental impairment, and even death. There are steps you can take to lower the risk and protect yourself and your children.


There are many different types of head injuries. 

  • Concussion. This is the most common type of head injury. A concussion is a type of traumatic brain injury (TBI) that happens when the brain is jarred or shaken hard enough to bounce against the skull. It can range from mild to severe. You don't have to be hit in the head to get a concussion. An impact elsewhere on the body can create enough force to jar the brain. 

  • Contusion. A bruise on the actual brain itself is called a contusion. It can cause bleeding and swelling. 

  • Intracranial hematoma (ICH). This is bleeding under the skull in the brain that forms a clot. Brain hematomas range from mild to severe and are grouped according to where they form.

  • Skull fracture. Sometimes, a broken skull bone can affect the brain. The broken pieces of bone can cut into the brain and cause bleeding and other types of injury.

The most common causes of head injuries are: 

  • Car or motorcycle accidents 

  • Falls

  • Child abuse

  • Acts of violence

A concussion or other head injury can also happen when two athletes collide or a player is hit in the head with a piece of sporting equipment. In soccer, even "heading" the ball can cause a concussion.

Among the sports-related activities that cause the highest number of head injuries for all ages:

  • Cycling

  • Football

  • Basketball

  • Baseball and softball

  • Riding powered recreational vehicles such as dune buggies, go-karts, and mini bikes

According to the Brain Injury Association of America, the five leading activities that cause  concussions in children and adolescents aged 5-18 years of age are:

  • Cycling

  • Football

  • Basketball

  • Playground activities

  • Soccer

Sports activities and trauma aren’t always the cause of head injuries. Contusions or brain hemorrhages can have other causes, such as: 

  • Long-term high blood pressure (in adults)

  • Bleeding disorders

  • Use of blood thinners or certain recreational drugs 

Signs and symptoms of a concussion may show up immediately, or they can take hours or even days to show up. You don’t always lose consciousness with a concussion. A concussion causes changes in a person's mental status and can disrupt the normal functioning of the brain. Multiple concussions can have a long-lasting, life-changing effect.

 Signs of a TBI, like a concussion, include:

Signs or symptoms that a head injury may be more than a concussion and requires emergency treatment include:

  • Changes in size of pupils

  • Clear or bloody fluid draining from the nose, mouth, or ears

  • Convulsions

  • Distorted facial features

  • Facial bruising

  • Fracture in the skull or face

  • Impaired hearing, smell, taste, or vision

  • Inability to move one or more limbs

  • Irritability

  • Lightheadedness

  • Loss of consciousness

  • Low breathing rate

  • Restlessness, clumsiness, or lack of coordination

  • Severe headache

  • Slurred speech or blurred vision

  • Stiff neck or vomiting

  • Sudden worsening of symptoms after initial improvement

  • Swelling at the site of the injury

  • Persistent vomiting

If you think you may have a concussion or suspect that someone else has one, the most important step to take is to prevent further injury. Stop whatever activity you are involved in and tell someone you think you may have been injured. Then get medical attention. If you're playing as part of a team, ask to be taken out of the game and tell the coach what happened. If a fellow player has signs of being confused or a sudden loss of coordination, be sure to report this to a coach. If you are coaching a team and you notice a potential injury, take the person out of the game, and see that the person gets medical care.

Receiving medical attention as soon as possible is important for any type of potentially moderate to severe TBI. Undiagnosed injuries that don't receive proper care can cause long-term disability and impairment. Keep in mind that although death from a sports injury is rare, brain injuries are the leading cause of sports-related deaths.

Symptoms should be closely monitored often with a moderate to severe injury. It may require an overnight stay in the hospital. A doctor may take X-rays to check for potential skull fracture and stability of the spine. In some cases the doctor may ask for a CT scan or an MRI to check on the extent of the damage that occurred. More severe injuries may need surgery to relieve pressure from swelling. 

If a child sustains a head injury, don’t automatically have them X-rayed. Monitor them carefully for age appropriate symptoms of a TBI such as confusion or behavioral change. Don’t give them medications, including aspirin, without advice from your doctors.

If the doctor sends you home with an injured person, they may instruct you to watch that person closely. That may involve waking the person every few hours to ask questions such as "What's your name?" or "Where are you?" to be sure the person is OK. Be sure you've asked the doctor and understand what symptoms to watch for and which ones require immediate attention.

Guidelines urge doctors not allow someone who has been injured to return to activity that involves risk of further injury until completely free of symptoms. Most teens recover within two weeks, while it may take younger children up to four weeks to recover. But symptoms of severe injury could persist for months or even years. A person with a moderate to serious injury will likely require rehabilitation that may include physical and occupational therapy, speech and language therapy, medication, psychological counseling, and social support.

The most important step to take is to buy and properly use protective head gear that has been approved by the American Society for Testing and Materials (ASTM). Be sure to buy the right size for a proper fit and to wear the helmet or headgear properly. According to the American Association of Neurological Surgeons, helmets or headgear should be worn at all times for the following activities:

  • Baseball and softball

  • Cycling

  • Football

  • Hockey

  • Horseback riding

  • Riding powered recreational vehicles

  • Skateboarding and riding scooters

  • Skiing

  • Snowboarding

  • Wrestling

In addition, the FDA has approved the noninvasive device, called Q-Collar which can be worn by athletes to help prevent head injuries. The C-shaped collar applies compressive force to the neck and increases blood volume to help reduce movement of the brain, which may occur because of hits to the head. The device may reduce specific changes in the brain that are associated with brain injury.

Other things you can do to keep yourself and your kids safer:

  • Wear light-reflecting clothes when riding a bike at night.

  • Don't dive in water less than 12 feet deep or any body of water where you cannot see the bottom, murky water.

  • Make sure that children's play areas and equipment are safe and in good repair.

  • Don't let children play sports that are inappropriate for their age.

  • Supervise and teach children how to properly use sports equipment.

  • Don't wear clothing that interferes with vision.

  • Follow all rules at water parks and swimming pools.

  • Don't skateboard or cycle on uneven or unpaved surfaces.

  • Don't play sports when you are tired or very ill.