Some Basics...

• There are many types of head injuries.
• Serious head injuries cause a person to lose consciousness or have other neurologic problems. People with serious head injuries should be seen in an emergency department. 
• There is always a chance that a person with a head injury also has a neck injury.
• Treatment depends on the type of injury.

Types of Head Injury

• Skin: Cut, scrape, bruise, or scalp hematoma ("goose egg").
• Skull: Fracture.
• Brain: Concussion and other injuries. Signs of these are loss of consciousness, amnesia, or other Acute Neurological Symptoms.

Acute Neurologic Symptoms: Call 911 if you have any of these after a head injury:

• Trouble waking up
• Confused or slow thinking and talking
• Slurred speech
• Weakness of arms or legs
• Shaky walking

Pain Scale

• None: No pain. Pain score is 0 on a scale of 0 to 10.
• Mild: The pain does not keep you from work, school, or other normal activities. Pain score is 1-3 on a scale of 0 to 10.
• Moderate: The pain keeps you from working or going to school. It wakes you up from sleep. Pain score is 4-7 on a scale of 0 to 10.
• Severe: The pain is very bad. It may be worse than any pain you have had before. It keeps you from doing any normal activities. Pain score is 8-10 on a scale of 0 to 10.

What is a Concussion?

A concussion is confusion or change in mental state after a head injury. People do not always lose consciousness.

• Symptoms: These may include headaches, an upset stomach, or feeling irritable and sleepy. Most often, these are felt during the first couple days after a concussion. Other symptoms include amnesia, poor memory, trouble staying focused, and decreased coordination. People may not feel like their normal selves. They may feel dizzy, tired, or dazed.
• Diagnosis: This is done by a doctor. A CT scan may be needed. This is normal.
• Classification: See American Academy of Neurology (AAN) grading scale below.
• Return to Sports: See the AAN guidelines below.
• What to Expect: Most people who get a concussion fully recover. They will have no lasting problems. A person may have symptoms that last for weeks or months.

AAN Concussion Classification

• Grade 1: Brief confusion. No loss of consciousness (LOC). Concussion symptoms or abnormal mental state on examination go away in less than 15 minutes.
• Grade 2: Brief confusion. No LOC. Concussion symptoms or abnormal mental state on examination last more than 15 minutes.
• Grade 3: Any LOC that lasts for either seconds or minutes.
• Note: All people with concussions need to be seen by a doctor.

AAN When to Return to Sports Guidelines

• Grade 1: After mental state is normal for over 15 minutes
• Grade 2: After mental state is normal for 1 week
• Grade 3: After mental state is normal for 4 weeks
• Note: Multiple concussions will need more time to recover. Athletes with concussions are sidelined to stop them from getting a "second impact injury." This is a second concussion that happens within 1-2 weeks after the first one. The result can be deadly.

Warning!

• Always consider the chance of a neck injury in people with head injuries.
• Watch for neck pain and arm or leg numbness or weakness. These may be signs of a neck injury.

1. What You Should Know:
   • There are many types of head injuries. There is skin (scalp) and bone (skull) on the head. There is also tissue (brain) in the head. These can all be injured.
   • You can treat minor cuts, scratches, and bruises at home.
   • Here is some care advice that should help.
2. Treatment of Minor Cuts, Scratches, and Scrapes:
   • Use direct pressure for 10 minutes to stop any bleeding.
   • Wash the wound with soap and water for 5 minutes.
   • Gently scrub out any dirt with a washcloth.
   • Put an antibiotic ointment on the wound daily.
3. Treatment of Bruise or Hematoma ("goose egg"):
   • Cold Pack: For pain or swelling, use a cold pack or ice wrapped in a wet cloth. Put it on the sore area for 20 minutes. Repeat 4 times on the first day, then as needed.
   • Heat Pack:
     • If pain lasts over 2 days, apply heat to the sore area. Use a heat pack, heating pad, or warm wet washcloth. Do this for 10 minutes, then as needed.
     • For widespread stiffness, take a hot bath or hot shower instead. Move the sore area under the warm water.
4. Observation: The person should be watched closely during the first 2 hours after the injury. You should wake him or her up 1 time every 4 hours for the first 24 hours. Check that he or she can walk and talk. It is normal for him or her to have a headache, upset stomach, or feel dizzy.
5. Diet: Drink clear fluids at first in case you vomit. After 2 hours, you can go back to your normal diet.
6. Pain Medicines:
   • You can take one of the drugs listed below if you have pain.
   • They are over-the-counter (OTC) pain drugs. You can buy them at the drugstore.
   Acetaminophen (Tylenol):
   • Regular Strength Tylenol: Take 2 pills (650 mg) every 4-6 hours. Each pill has 325 mg of acetaminophen.
   • Extra Strength Tylenol: Take 2 pills (1,000 mg) every 8 hours. Each pill has 500 mg of acetaminophen.
   • Do not take more than (3,000 mg) of this drug per day.
   Ibuprofen (Motrin, Advil):
   • Motrin and Advil: Take 2 pills (400 mg) every 6 hours. Each pill has 200 mg of ibuprofen.
   • A second choice is to take 3 pills (600 mg) every 8 hours.
   Naproxen (Aleve):
   • Aleve: Take 1 pill (220 mg) every 8 hours. Each pill has 220 mg of naproxen.
   • A second choice is to take 2 pills (440 mg) every 12 hours.
   Extra Notes:
   • Use the lowest amount of a drug that makes your pain feel better.
   • Your doctor might tell you to take more than what is shown above. That is because your doctor knows you and your health problems.
   • Acetaminophen is safer than ibuprofen or naproxen in people over 65 years old. Acetaminophen is in many OTC and prescription drugs. It might be in more than one drug you are taking. Be careful how much you take. Too much of this drug can hurt the liver.
   • Caution- Acetaminophen: Do not take it if you have liver disease.
   • Caution- Ibuprofen and Naproxen:
     • Do not take ibuprofen or naproxen if you are pregnant.
     • Do not take these drugs if you have stomach problems or kidney disease.
     • Do not take these drugs for more than 7 days without checking with your doctor.
   • Read all package instructions.
7. What to Expect: Most head trauma only causes an injury to the scalp. Pain and swelling most often get better 2-3 days after an injury. Swelling is most often gone in 7 days. Pain may take 1-2 weeks to go away.
8. Call Your Doctor If:
   • Pain becomes severe
   • Neurological Symptoms (see above) occur during the next 3 days
   • You get worse