At a glance
What it is
Trauma to the head that may affect the scalp, skull, or brain — ranging from mild concussion to severe intracranial haemorrhage.
Emergency signs
Loss of consciousness, vomiting, seizure, worsening headache, weakness on one side, unequal pupils, clear fluid from nose or ear.
How we treat it
Immediate CT to stratify risk; observation, surgical evacuation of significant clots, and structured rehabilitation for the deficits that remain.
What head injury covers
Head injury is a broad term. At one end sits a mild concussion — no imaging changes, symptoms clear within days. At the other sits a major intracranial bleed that needs an emergency operation within the hour. The whole spectrum is triaged by the same clinical framework: level of consciousness (Glasgow Coma Scale), pupil examination, focal neurology, and — for anything but the mildest injury — a CT scan.
Getting the CT right is the pivotal decision. Missed bleeds kill; unnecessary CTs cost money and radiation without gain. Validated decision rules (Canadian CT Head Rule, NEXUS) tell us which patients need imaging and which can be safely observed.
Everyone worries about the operation. What matters more is the twelve hours after: seizure, re-bleed, rising pressure. The bedside review, not the theatre, is where most patients are saved.
Two intracranial injuries you must not miss
The two most time-critical intracranial injuries look different on imaging and behave very differently. Both need urgent surgical assessment; the outcome depends on how fast the operation happens.
Injury A
Extradural haematoma
- Bleed between skull and dura, usually from a torn middle meningeal artery.
- Classic lucid interval: lose consciousness, wake up, then deteriorate.
- Excellent outcome if evacuated early; devastating if missed.
Injury B
Acute subdural haematoma
- Bleed under the dura, typically from torn bridging veins.
- More common in the elderly and in patients on anticoagulants.
- Prognosis heavily depends on underlying brain injury, not just the clot.
What we see in clinic
80%
Of head injuries are mild — normal CT, symptoms resolve within weeks
15%
Are moderate — imaging changes, structured observation and rehab
5%
Are severe — surgery, intensive care, long-term rehabilitation
Key facts
How it is managed
Care spans emergency assessment, surgical intervention where indicated, and structured rehabilitation. Most patients only need the first two boxes; a minority need the full pathway.
Emergency assessment
First hours
- Glasgow Coma Scale and full neurological examination
- CT head — always in moderate or severe injury
- Cervical spine imaging in polytrauma
- Blood tests including coagulation panel
Surgery
When indicated
- Craniotomy and clot evacuation for extradural or acute subdural haematoma
- Burr holes for chronic subdural haematoma
- Decompressive craniectomy for refractory raised intracranial pressure
- Depressed skull fracture elevation
Observation & medical care
The majority of cases
- Neurological observations every 30 min to 1 hour
- Repeat CT if any deterioration
- Anticonvulsant prophylaxis in selected injuries
- Analgesia and antiemetics
Rehabilitation
The long tail
- Cognitive rehabilitation for memory and attention
- Physiotherapy for motor recovery
- Speech and language therapy where affected
- Vocational assessment for return to work
The acute phase is managed at the emergency department. The clinic sees patients afterwards for follow-up, rehabilitation, and secondary prevention.
Related reading
Stroke
A medical emergency where blood flow to part of the brain stops, and every minute counts. We handle recovery and preventing another stroke.
Brain tumour
An abnormal growth in the brain. Whether it needs surgery, radiation or monitoring depends on its type, location and effects, decided together.
Book a consultation
The secretary schedules first appointments during clinic hours; please have prior imaging, operative notes and a current medication list available at the time of the call.
This page provides general information about head injury and is not a substitute for individual medical assessment. If your symptoms are severe or worsening, contact a clinician promptly.