Head Injuries

Symptoms

• Headache: Persistent or worsening head pain after a bump, fall, or blow to the head.
• Dizziness or balance problems: Feeling unsteady, lightheaded, or off-balance.
• Nausea or vomiting: One episode is common with concussion; repeated vomiting is a red flag.
• Confusion or memory gaps: Trouble concentrating, feeling foggy, or not remembering the injury.
• Blurred or double vision: Visual changes or sensitivity to light and noise.
• Drowsiness: Feeling unusually sleepy or being difficult to wake.
• Mood or behavior changes: Increased irritability, sadness, or unusual behavior, especially in children.
• Neck pain: Pain or stiffness that can accompany head and neck trauma.

When it's an emergency

Call 911 immediately for loss of consciousness, a seizure or difficulty waking after a head injury. Seek emergency evaluation for any head injury with these red flags, which can signal a serious traumatic brain injury (TBI) or bleeding inside the skull: loss of consciousness (even briefly), repeated or forceful vomiting, worsening or severe headache, seizures, or a person who is hard to wake or increasingly confused.

Other danger signs include unequal or dilated pupils, slurred speech, weakness or numbness in an arm or leg, and clear or bloody fluid draining from the nose or ears. In infants, watch for persistent crying, refusal to eat, or a bulging soft spot on the head.

Be especially cautious with high-risk injuries: falls from a height, car crashes, sports collisions, or any head injury in someone taking blood thinners or with a bleeding disorder. Do not "wait and see" with these. Bleeding can worsen over minutes to hours.

Bellaire ER is open 24/7 with an on-site CT scanner, so you do not need to wait for a hospital appointment to find out whether a head injury is serious. If the scan shows bleeding, we stabilize you and arrange rapid transfer for hospital neurosurgical care.

When it's not an emergency

Many minor head bumps do not need emergency care. If an adult stayed fully awake and alert, had no loss of consciousness, and has only a mild headache, a small bump, or minor tenderness, it is often reasonable to watch closely at home for 24 to 48 hours.

A mild, stable injury with no red flags can be watched at home, and Bellaire ER has CT on site 24/7 if you would rather be certain than wait and see. A small scalp cut can be closed here the same visit. A telemedicine visit is a convenient way to review your symptoms and decide whether you need to be seen in person.

Whoever is watching the injured person should look for warning signs that develop later: worsening headache, repeated vomiting, confusion, drowsiness, or trouble waking. If any of these appear, treat it as an emergency and go to the ER. When in doubt, especially with children, older adults, or anyone on blood thinners, it is safer to be evaluated.

What else could be causing this

Concussion

A disturbance of brain function from a blow or a sudden jolt, with no bleeding visible on a scan. Headache, feeling foggy, dizziness, light and noise sensitivity, and a gap in memory around the impact are typical. A normal CT does not mean there was no concussion, the two answer different questions.

Scalp laceration or hematoma

The scalp has a rich blood supply, so a small cut bleeds dramatically and a bump raises a firm swelling that can be alarming to feel. These are usually the least serious part of a head injury, but they bleed enough to need direct pressure and sometimes closure, and the swelling can take weeks to fully settle.

Skull fracture

A break in the bone, which may be a simple line, a depressed segment, or a fracture through the base of the skull. Bruising behind the ear or around both eyes, blood or clear fluid draining from the nose or ear, or hearing loss after an impact point toward a basilar fracture. Fractures matter mainly for what lies beneath them.

Epidural hematoma

Bleeding from an artery between the skull and the brain's outer covering, often with a fracture of the thin bone at the temple. The classic pattern is a brief loss of consciousness, a period of looking and feeling relatively normal, then rapid deterioration over the following hours. That deceptive middle period is the reason a reassuring first hour is not reassurance.

Subdural hematoma

Bleeding from veins beneath the brain's covering. It can be sudden after a significant impact, or slow and silent over days to weeks after a minor bump: most often in older adults, people on blood thinners, and people who drink heavily. Headache, gradual confusion, drowsiness or a change in personality weeks after a forgotten fall is the pattern to know.

Bleeding or bruising within the brain

Subarachnoid blood, a contusion, or bleeding into brain tissue itself. Severe headache, vomiting, weakness or numbness on one side, slurred speech, visual changes or a seizure after injury point here. This group is what makes an urgent CT scan the deciding test rather than a precaution.

Neck injury alongside the head injury

Any force large enough to injure the head can injure the cervical spine. Neck pain or midline tenderness, pain on moving the neck, or numbness, tingling or weakness in the arms or legs changes what happens next, the neck is immobilized and imaged rather than examined through movement. It is the injury most often overlooked because the head injury has everyone's attention.

A medical event that caused the fall

Sometimes the head injury is the consequence, not the cause. A faint, an abnormal heart rhythm, a seizure, a stroke, low blood sugar, dehydration, a new medication or alcohol can all put someone on the ground. If you do not remember falling, or the fall came out of nowhere without a trip or a slip, finding out why is as important as examining the head.

What happens when you arrive

At Bellaire ER, a board-certified emergency physician evaluates you quickly, reviews how the injury happened, and performs a focused neurological exam checking your alertness, memory, pupils, strength, and balance.

When the exam or your symptoms suggest a risk of bleeding or a serious traumatic brain injury, we perform a CT scan of the head on-site. This helps the physician assess bleeding, swelling, or a skull fracture.

We diagnose and treat in a single visit. Care may include cleaning and closing scalp lacerations, managing pain and nausea, and monitoring you until you are stable. Most patients are treated and discharged with clear instructions; if a rare finding requires a neurosurgeon or hospital admission, we coordinate a safe transfer.

Before you leave, your physician explains your results, reviews concussion recovery and return-to-activity guidance, and gives you specific warning signs that mean you should come back.

Tests we can run on site

Neurological examination

The foundation of the evaluation. A physician assesses alertness and orientation, memory of events before and after the impact, pupil size and reaction, eye movements, speech, strength and sensation in all four limbs, coordination and balance. Together these localize a problem and set the baseline that later checks are compared against.

CT scan of the head

The test that answers the urgent question: is there bleeding, swelling or a fracture. It takes minutes, requires only lying still, and is available on site. It is the reason a head injury can be sorted out here rather than somewhere else, and whether you need one is a decision made from established criteria: age, mechanism, blood thinners, loss of consciousness, vomiting and examination findings, not from how hard the bump looked.

CT scan of the cervical spine

Imaging of the neck bones, added when there is midline neck tenderness, a dangerous mechanism such as a fall from height or a car crash, or when the examination cannot be relied on. It rules a fracture in or out before the neck is moved freely again.

Serial observation and repeated neurological checks

Bleeding inside the skull can develop or enlarge over hours, so a single normal examination is a snapshot. Being monitored, with the examination repeated at intervals, is how a change is found while you are still in the building. For some injuries this period of watching is the test.

Blood work

The on-site laboratory checks clotting. Which matters a great deal if you take warfarin or another blood thinner: along with a blood count, blood sugar, sodium, and kidney function. These both guide treatment and help explain a fall that had no obvious cause.

EKG and cardiac monitoring

Used when the fall followed a faint, palpitations or chest pain. An abnormal heart rhythm that caused a collapse will cause another one, and finding it changes the whole plan.

X-ray

On-site plain imaging for the other injuries that come with the same fall: wrist, shoulder, hip, ribs. These are easy to underplay while attention is on the head, and they are often what limits recovery afterward.

Treated here, or transferred

Bellaire ER is a licensed freestanding emergency room, open 24 hours a day, 365 days a year, staffed by board-certified emergency physicians and nurse practitioners, with on-site CT, X-ray, ultrasound and laboratory, and medication given on site during your visit. It is equipped for emergency evaluation, stabilization and treatment, and it is not a hospital. There is no neurosurgeon and no intensive care unit in a freestanding emergency room, and the evaluation is built around finding out whether you need one.

Most head injuries are handled here from start to finish. A CT scan showing no bleeding, a reassuring and stable neurological examination, and a reliable adult to watch you means concussion care, pain and nausea treatment, scalp wound cleaning and closure, a tetanus update if needed, medication given during your visit, a prescription written for anything you need afterward, and written return-to-activity guidance before you go.

Observation is often part of the treatment. For an injury where the risk is a change over the next few hours, being watched here with repeated examinations is what the visit is for.

Bleeding inside the skull, a depressed or open skull fracture, a cervical spine fracture, a seizure after injury, a patient on blood thinners with a bleed, or anyone who needs neurosurgical assessment, admission or intensive monitoring will be stabilized here and transferred to the appropriate hospital service. Stabilization means airway and breathing support, blood pressure control, pain and nausea treatment, immobilization where the neck is involved, and the imaging already in hand so the receiving team is not starting over. Transfer is a normal part of how a freestanding emergency room works, not a failure of the visit.

Children

Bellaire ER treats adults and children. Most childhood head bumps are minor, and the decision about imaging is deliberately conservative: established criteria identify which children are at low enough risk to be observed rather than scanned, because a CT in a child carries a radiation consideration that it does not in an adult. A physician recommending a period of watching instead of a scan is following that evidence, not cutting a corner.

Children show warning signs differently. In an infant or toddler, look for a bulging or tense soft spot, persistent high-pitched crying that cannot be settled, refusing to feed, repeated vomiting, a large or soft swelling anywhere other than the forehead, unusual sleepiness, a seizure, or a child who is simply not acting like themselves. Any loss of consciousness, any vomiting more than once, any suspected skull fracture, or any injury in a baby under a year old should be evaluated in person.

The mechanism carries weight with children: a fall from a significant height: roughly more than three feet for an infant or five feet for an older child, a fall down stairs, being struck by a vehicle or a bicycle crash without a helmet, or a high-speed collision all raise concern regardless of how the child looks afterward.

After a concussion, children need a return to school before a return to sport, with a stepwise plan and clearance. Tell the school so that work can be reduced for a period. Younger children recover on a similar timeline to adults, but they are less able to say what is wrong, so irritability, clinginess, sleep changes and declining schoolwork are the symptoms to watch for.

Where an injury does not fit the account given: an injury in a baby too young to move themselves, bruising in several places of different ages, or a history that changes. Clinicians are required to look into it. Those questions are part of caring for the child and are asked routinely.

After you leave

A normal scan describes the moment it was taken, so the 24 to 48 hours after a head injury are watched rather than assumed. Someone should stay with you, know what to look for, and be able to wake you and get a sensible answer. It is fine to sleep, the old advice about keeping someone awake all night has been replaced by checking that they rouse normally.

Call 911 immediately for loss of consciousness, a seizure or difficulty waking after a head injury. Seek emergency evaluation for a headache that keeps getting worse, repeated vomiting, increasing confusion or difficulty waking, a seizure, weakness, numbness or clumsiness in an arm or leg, slurred speech, double vision, unequal pupils, or clear or bloody fluid from the nose or ear. A stiff neck, or new neck pain with tingling in the arms, also means return. These same instructions matter more, not less, if you take a blood thinner.

Concussion recovery has a shape. The first day or two is relative rest: less screen time, less noise, no driving while you feel foggy, and no alcohol. After that, gradually resume normal activity at a level that does not markedly worsen your symptoms, rather than lying in a dark room for a week, which slows recovery. Return to work or school in steps. Do not return to contact sport on the day of the injury under any circumstances, and only return to it through a stepwise plan cleared by a clinician, because a second impact before the first injury has healed causes disproportionate harm.

Most people improve substantially within one to four weeks. Headache, poor sleep, irritability, difficulty concentrating and feeling easily overwhelmed are expected parts of that, not signs of damage. Arrange follow-up if symptoms are not improving after two weeks, and be aware that in older adults and people on blood thinners a slow bleed can appear weeks after the injury: new headache, confusion, drowsiness or a change in personality during that period is a reason to be seen again, even for a fall that seemed trivial at the time.

Lowering your risk

Many head injuries are preventable. Always wear a properly fitted helmet for cycling, skating, contact sports, and riding motorcycles or ATVs, and buckle up every time you are in a vehicle.

Reduce fall risk at home by securing rugs, improving lighting, using stair railings, and installing grab bars for older adults, who are at higher risk of serious injury. Use age-appropriate car seats and supervise young children near stairs and playground equipment.

After a concussion, follow your physician's return-to-play and return-to-activity guidance. Suffering a second head injury before the first has healed can lead to more serious harm.