When to Go to the Hospital

Question: 

People who've just had their brains jostled may be in no condition to decide if they need medical care. And the people around them may not know that hitting your head can be dangerous even if you don't lose consciousness. How do you know when you should go to the hospital after having "your bell rung"?

Answer: 

Going to the hospital after a head injury can mean the difference between life and death. But how do you know when to go? This can seem like a difficult decision, but let me sum up the answer for you: when in doubt, go to the hospital. Not later. Not tomorrow. Now!

Here's why.

The hospital is the only place that has a CAT scanner that can "look" inside your head and determine if there is any bleeding in your brain. Bleeding in the brain can be life-threatening when there is enough blood in the right spot to press down on the brain and squeeze it. These dangerous forms of bleeding are called epidural and subdural hematomas. Because the brain is trapped inside the skull, slow bleeding can force important parts of the brain against the inside of the skull and through the small hole in the base of the skull called the foramen magnum. These important brain areas, which control breathing and heart rate, stop working when they get squeezed and this is what results in death. With a CAT scan, epidural and subdural hematomas are easily diagnosed. The treatment requires surgery to remove the blood clot. The quicker the surgery, the better the chances for a good outcome.

So, how do you know when to go to the hospital? The decision is easy if you're the one making it for someone else and that person is not responding to you or looks asleep. This is called coma. The risk of a subdural or epidural hematoma in comatose head injured patients is high and you should summon an ambulance immediately!

But what if the head injury doesn't cause a coma? What if the head injury just causes a brief loss of consciousness, brief period of amnesia, or a sensation of feeling dazed? A person who has such an injury — termed concussion or mild traumatic brain injury — can look, and even feel, just fine. The problem is, even though the person looks good on the outside, inside the skull there is a small chance that slow bleeding is taking place. After a concussion, the chances of this happening are not large — about 1 in 1000 — but the only way to diagnose it is with that hospital-based CAT scan.

Here are the symptoms of a concussion that should prompt an immediate trip to the hospital or emergency department.

  • Loss of consciousness, even if only briefly
  • Any period of amnesia, or loss of memory for the event
  • Feeling dazed or confused
  • Headache
  • Vomiting
  • Seizure
  • In addition, for children under 2 years of age, any scalp swelling or abnormality in the way they usually behave.

One word of caution: because any brain injury — even a concussion — has the potential to injure the brain, the brain-injured patient may lack the judgment to make an informed decision regarding whether or not to go to the hospital. Family and friends can be instrumental in helping the patient chose a course of action that is best for him or her. And when in doubt, go to the hospital!

Posted on BrainLine April 8, 2009. Reviewed July 25, 2018.

Jeffrey Bazarian

Dr. Bazarian is an emergency physician with a strong research interest in traumatic brain injury. He is associate professor of Emergency Medicine, Neurology, and Neurosurgery at the Center for Neural Development and Disease, University of Rochester Medical Center.

Comments (357)

I was at the park with my friends and we were playing Marco Polo. I was slipping off the red swirly thing that you climb up on and I fell. I hit my head on the metal part of the structure and my arm got hit on every single bump of the red swirly thing and I have bruises all over my arm. I have a bump on the left side of my head. It hurts constantly. I got picked up early from school today. It was bleeding when it happened yesterday.. It hurts after I smile or when I raise my eyebrows. What should I do to feel better?

Hello My 6 year old fell in the bathtub and hit the temple part of his head. He has a slight bump and bruise. He said he has a headache but otherwise acting normal. Should I go to the hospital?

i was at a parade ang got into a fight with someone and all of his friends jumped me i was kicked in the head a few times and i noticed a small dent in my skull... what should i do

I fell down in my garage 3 days ago going up a step flat on my back hitting my back, and head on the concrete it and I cried, but I got up and got some paper towels to help apply pressure. The bleeding stopped I went into the house and sat for a while, I have a lump on the ( R ) side of my head and the base of my skull, and neck feels swollen my shoulder's hurt and spasm also my lower back hurts. Do you think it's to late to go to the ER, or see my doctor on Monday??

Today I was at the park with my family I was trying to do a pull up on the monkey bars. I thought there was enough space between my head and the other pole behind me but there wasn't. When I went up my head hit the pole. It hurt bad not to the point where I was gonna cry, but it did hurt. It's been a couple of hours and I have a light headache and when I touche the top of my head it hurts, should I be worried? (I am 12 years old)

A week ago I got hit on the head with a roof window pretty hard, and it started bleeding. Half an hour later I felt really dizzy and weak, and I had to sit down for a while. I went to the doctor, no stitches were needed as the cut was not deep, but used glue to stop the bleeding. I still feel pain,at times just a sharp pain, or a headache during the day. The pain does not last long but almost everyday, and sometimes when I am standing I feel dizzy. Is this normal?

I was involved in a very serious car accident where the car went off a cliff. I was thrown up and down over and over again as the car rolled over and over and over down a two thousand foot cliff. I received several injuries which mostly were minor except for a burst fracture of T12 and my spinal canal was closed 50% with bone fragments. I received two Harrington rods, bone out of my hip to replace the crushed vertebrae in my back. I also sustained an injury where I hit the back of my head really hard and had to receive roughly ten stitches.

My problem and questions are: what head injuries did I receive? I have short term memory loss which is driving me crazy. It is so frustrating (to say the least) to not remember where you put your keys seconds after putting them down. Maybe you can help me? What should or could I do???

I had a craniectomy about 6 1/2 months ago. They basically removed part of my skull and extended part of the muscles holding the brain. About two months ago I tore those muscles and was leaking cerebrospinal fluid. A couple of weeks ago they said it’s still healing.

Yesterday I hit the base of my head pretty hard on a wall where the surgery site and tear was. Today I’ve been having horrible headaches and my neck is so strained. I can’t move and it goes to the middle of my back. I’m also dizzy and can’t concentrate. I’m not sure if I should go in to see if I tore it again or if I should wait it out.

About a week ago my friends had a fight and threw a metal cup that ended up hitting me in the side of the head right by my ear. I iced it but the lump is still there. It still hurts. I have to sleep on my belly with my hands on my forehead. I can't sleep with my head on a pillow because I get light headed and eye pains. I can't brush my hair and I feel like its swelling but it's not. I don't know if I should go to the hospital or not.

My boyfriend was playing basketball, he is very competitive, and he slammed into someone and then hit his head on concrete. He ran the mile today and collapsed to his feet when he was done. I texted him because I was worried and he said his head hurt and that he's been vomiting every 10-15 minutes or so. I am really worried.

I really hope he went to the hospital. Is he doing ok?

He needs medical care

My 7your old daughter was running in school yesterday and fell and hit her head on the side of a table. She was giving an ice pack but school didn't ring me, she was very cranky last night crying alot just not her self she woke this morning and got sick what should I do???

You must take her to the hospital.

I suffered a head injury in a car accident three months ago I’ve since then have the same things I cry all the time staying confused having memory loss be sure she doesn’t have the same symptoms watch for these things I would be sure to have her tested ct scan mri is definitely what you should have her check out as soon as possible

Three weeks ago, one of my twins(3.5yo) was at the bottom of a sledding hill when his brother sled into him, kicking him in the face(according to both). I was at the top of the hill and couldn’t assess the impact. The twin who got hit vomited a little, as if spitting, and then 5minutes later in the car he slept. I thought he had gone unconscious and I shook him which startled him and he started crying. We spoke to a physician over the phone who advised to keep an eye on him re vomiting and lack of consciousness. He slept for an hour with me waking him every 15 minutes to check on his reactions. After an hour nap, he was running around happily. His lip and cheek was a bit swollen but we assumed that if no vomiting and if in good spirits, then it was not a major impact and he was fine. Four days later, he woke from a nap vomiting and we got worried whether it is related to head injury. In Urgent Carentjey said he didn’t have a concussion. He has been his energetic self since. But I still wonder if there is a risk for a blood clot forming andnifnwe should have taken him to the hospital for a CT scan? Thanks for your thoughts!

Had a door hit me three weeks ago, dog loves to run across the porch and hurl his 90lb body into the back door and I happened to turn the handle right as he hit. Within seconds the area swelled enough to fill my hand, like the amount of time it took to reach up and touch it. No loss of consciousness, no amnesia, a little nausea but I also have anxiety which can cause nausea too. I still went to work an hour later and we called the doctor on my lunch but they said they didnt think it warranted a visit. Since that day I've had headaches galore, I get dizzy very easy (which is very uncommon for me, normally I can walk straight in under 10 seconds after spinning rapidly, great party trick), and the area still hurts when I touch it. Should I bring it up to the doctor again or is it just taking a while to heal fully?

If you've been having symptoms after 3 weeks, I'd suspect it's a concussion. I think you should definitely bring it up to your doctor again.

I have post concussion syndrome and I got drunk last night like an idiot and hit my head several times.
I’m in a huge daze and can’t focus on anything
Am I dying? I’m so tired

Hi, I am a 77-year-old lady. I fell and hit my forehead very hard on the coffee table. I did not pass out but had a large bump on my forehead. I went to A&E and the doctor just looked, asked a few questions, and then sent me home. I now have black eyes and have been sweating a lot. Could that be because I am worried something may happen to me? Also, I am flying to America at the end of April. Should it be ok to fly? I'm so worried.

My husband hit me on the rightside of my brain and I have feeling losing my balance and strong pain on the right side of head and face. Please help me. What to do? Are these symptoms of head injury?

Your husband hit you it’s time to LEAVE. Next step is death

My husband had been drinking alcohol, he fell and cut the top of his head. He had already vomited prior to the head injury. It has been about an hour and it is still having some bleeding. I know that head injuries always bleed more but how do I know of I need to take him to the hospital.

I had a massive arguments with my boyfriend and I hit my head in the wall 3 times and I feel dizzy and I got a headache and I’m just worried what should I do

...with my boyfriend and he* hit my head in the wall 3 times...

I recently found a spot on my headed about almost 3 inches from my ear, it hurts and feels swollen. It hurts just by moving my hair. It's slightly red but no one really can see what I'm talking about. It hurts bad. I've been off balance, but that's about it. I have been getting headaches. Please give me advice. I'm a M.A. so I'm not quick to run to the er and this just makes no sense to me, it's so random, and it's only in one spot that hurts so bad. All my hair looks normal no pus or anything. All hair intact. Please help. In trying to avoid the er.

I hit my head pretty bad when I fell and I twisted my neck. I've been having bad headaches the past few days and it got a lot worse. After the fall, I felt dizzy. I was able to function well with our project but after that, it felt like I was floating. Honestly speaking, everything I did, I forgot. Should I speak with my doctor tomorrow?

you need to go to the hospital.

My husband passed out during the birth of our son and hit the back of his head so hard that it took 2 mins for the nurses to get him to come to. He was taken to the ER and they never did a cat scan. For 48 hours he slept then the next 48 he threw up and slept on and off. Then he started acting very angry and irritable. He thinks nothing is wrong and will not get checked out. Is there anything I can do?

Hi, I got slammed into the floor last night, hitting my head and was also shaken very vigorously. This morning i am slow, dizzy, nauseas, i have swelling the back of my head, feel a lot of pressure in my head and breathing slow. Im pretty worried. I have no insurance or money for the doctor. If it is serious would ibprofen help?

Go to the hospital now. I just came home from taking a family member with the same symptoms to the hospital. She had a brain bleed, had surgery last night, and is doing well. Please go now!

You need immediate medical attention if you haven’t gotten it yet.

Go to the er. They can’t reject you

I got hit in my left temple a few days ago , its bruised and still hurts to lay on that side or touch it. Is it serious or should i just let it heal ?

Go to hospital immediately if you have not yet. Tell them how you feel. If one hospital doesn’t take you then go to another but try, ASAP.

My dogs were running behind me and knocked my feet from under me. I flew up in the air and came down very hard flat on my back. My head hit pretty hard and bounced once, but I don't think I lost consciousnesses. Today my neck hurts, my back hurts, and it feels like I did 100 sit ups yesterday? Is this normal or should I be concerned?

If you are dazed at all you need to go to the hospital and tell them what happened.

I got socked in the head about a week ago and it left a big lump on the right side of my head and left me feeling extremely dazed. I’ve been having headaches nearly every day and find it hard to move as quickly as I normally do without making my head rush or feel light headed. My head hurts everyday when I wake up and this morning it is hurting a lot. What should I do? No one other than one person knows I got socked in the head.

Today I smashed my head into a wall. It's red swollen bleeding and I have a really bad headache that just won't go away.

Hi Alyssa, Can you make an appointment with your primary doctor or your GP?

If I banged my head by fainting twice yesterday and still dizzy and sick today sure I go hospital.

About 1 and half weeks ago I hit my head and knocked myself out (type1 diabetic had a low blood sugar ). I was seen my a dr in my local ed and sent home. Headache won’t go and I still don’t feel like my normal self. Worried.

My 11 yr old got hit in the right temple (forehead) with a metal water bottle at school. I wasn't there, but was told is was harder then a tap, and she had some swelling. Took her to urgent care to be looked at a day later and they said she doesn't have a concussion. However, today I received a call from the school nurse that her head hurts still, and last night she woke up complaining of the same thing. I gave her Motrin and it helped. The school gave her Tylenol, and that helped. Should I take her to the ER or should I see if it gets better.

Have you tried calling her primary care doctor? They would probably be able to provide guidance.

Hi -looking for some advice on post-concussion symptoms (6 mos. plus?). Back in July 2018 (6 mos. ago) took a fall, missing a 10" step onto a tiled floor. Never hit the ground but came within a few inches. Jerked myself up --all on the right side. Within 10 days neck pain, dizziness, headaches, exhaustion & insomina ensued. Told I had severe whip lash. Been to lots of docs since: GP, neurologist, orthopedist, and then mostly recently naturopathy and an osteopathy (who finally said you actually had a concussion and mild TBI) . HAd the typical MRI (got a thumbs up your brain looks good) back in August; x-ray of spine & neck also all good. Just showing some arthritis in neck from a similar neck injury. My nagging symptoms: muscle tightness and milder pain still in neck but more disturbing is headache daily over right eye, hot/warm feeling when turning head to right side and occasional facial numbness and tingling --mostly if I work too much, dont get enough sleep. Just concerned after 6 mos. why not going away !! I am 52 year old Mom who works part-time now, volunteers at school/scouts but still can't get back to full-time regular life activities. Any advice from someone with similar stuff ?

I would try a chiropractor! I had a whiplash injury years ago and chiropractic adjustments were the only thing that helped me.

Look into concussion therapy which is a type of physical therapy. My husband did the same thing - slipped down our stairs, briefly his head hit the stair and he didn’t even realize it. He was diagnosed with a concussion as well and had all the typical symptoms but they would not get better even months later and they affected his ability to focus, concentrate, his eyes wouldn’t work together, he was extremely moody (and he’s normally really mellow). He mentioned it to his PT who was working on the tension in his neck and back from the fall and the PT sent my husband to their concussion specialist who put him in a program to retrain his brain after the injury. It was extremely hard, but it worked and finally more than six months after the initial fall he was feeling more like himself. Find a concussion specialist. There is so much involved with a concussion. It is not just a brain bruise that needs time to get better. Good luck!

I got hit in the head with a beer bottle multiple times. Not hard enough to lump or anything but it hurt for a couple of days.  Since then I started having head pain. I can’t tell where coming from but think it’s the top of my head. I went to the hospital and had a cat scan. It’s been two weeks now with nonstop dull pain in my head that doesn’t go away. The pain just started 2 weeks ago but the hit was like 2 to 3 weeks before that. The cat scan came back ok. They said they didn’t see anything and since I can’t point out where exactly it’s hurting in my head they can’t do anything. I stress a lot over many things. Am I going to be ok? Could it just be stress? Am I going be ok since they said cat scan came back ok or should I still worry? I’m really worried.  Not sure how to check responses on here. please make sure I can see. I am worried

I'm so sorry that this happened to you Nolan.

Please do not worry honey, it will work out. I can't offer you an immediate solution but I can tell you what I would do. What I HAVE done. What I'm CURRENTLY in the midst of, lol!

Nolan, you're not crazy and I may SOUND like I am, lol, but rest assured, I am not (my family debates that).

Okay, since the scans have come back okay, you can start ruling things OUT... troubleshooting. This is good but there are a few things you might want to get in order first.

One, if you have a primary physician that listens to you that you trust, speak with them about how you're feeling. Explain that you will be needing to do some tests to rule out whatever is needed to in order to figure out whatever this mystery condition is that you have is so that you can start treating it RIGHT AWAY.  Nolan, if they are not on board, you find a physician who will be and work EXTREMELY closely with them. They may ask you to see specific specialists. Do it. 

Now, this is not to say that you have to start taking a bunch of meds. They may try to do that... throw meds at ya to get you out of their hair. All that will do is treat symptoms. You want to treat the condition or disease, not just the symptoms. Run labs/tests/samples and make sure that if it's not uploaded into a shared system, YOU GET COPIES. This way, your primary and special teams have access.

Next, support. You need to make sure you have someone to unload on. This stuff can get really overwhelming... therapy rocks. Lean on friends and family... sign up for yoga dude.

Lastly but MOST importantly. Believe whatever you will my dear but trust in God. THE HIGHER POWER. If you can just Trust for that Guidance even the slightest amount, you will see that this burden is MUCH lighter to carry at these super heavy times.

Slow it down a bit, be in the moment, understand that the journey you're about to embark on is an amazing one. It's one of strength, perseverance and humility.

Also... get yourself the audible book "The Mindful Way Through Depression". Not saying you're depressed, love. However, research shows that when people begin to suffer pain that interferes with life, stress, anxiety and depression have an easier foothold. This book breaks it down SO WELL and it has meditational exercises that were helpful as well.

Congratulations Nolan! You're about to tap into a new, better, stronger, you! God Bless You!

I slipped on ice yesterday and landed straight on the back of my head. Surprisingly there’s no lump on my head and its not too sore to the touch. But I am experiencing whiplash and can’t move my neck well and I get very tired when I move my face or try talking. I also feel as if my eyes are criss crossed and seem very sensitive to light. It’s also strange bc it has seemed to affect the left side of my brain and body more. My left side of my brain and my face will feel heavy and numb and fuzzy. I don’t know what’s happening.

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