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!

When in doubt, go to the hospital!

Posted on BrainLine April 8, 2009. Reviewed March 28, 2019.

Comments (411)

Please respond.

I was in an extreme car accident 6 Yers ago and cut my head open, had bleeding in the brain, I’ve had two bad concussions in the past year and 3 days ago I got another concussion against the bus roof.

Been to two doctors and they both confirm it’s a concussion and worry about my TBI.

I’m on meds and everyone is telling me to get rest and that if I don’t feel better an hour after meds, then I should go to the hospital.

I don’t feel better yet they tell me to sleep it off.

My head is heavy. I'm nauseous. I feel dizzy. I keep having memory loss of the past two days and I can’t sleep.

What do I do?

I fell from a standing position and hit my head on the tile floor. I did not lose consciousness when I hit the floor but I have no memory of what caused the fall. I was bleeding and had terrible vertigo and head and neck pain so went by ambulance. I had a CAT scan and X-ray- no bleeding. They told my sister I did not have a concussion but I disagree. The Vertigo, constant headaches, sleepiness and shakiness are not my imagination. My sister and I argued over whether or not I had one - I don’t know why. I decided if I was okay then I would take a shower. The vertigo onslaught happened in the shower. I was terrified because I couldn’t get my balance. I tried calling for help but no one heard me. I blacked out and hit my head - again on the floor/side of bathtub. When I came to I freaked out. The Vertigo was still effecting me, I hurt my foot in some way, but I was mostly afraid I’d done real damage to my head, hammering it twice in less than a week. No bleeding this time except where I had apparently bit my lip. My brother-in-law had to get me out of the tub and half-carry me to my bed. He got me ice for my head. No one can take me to the hospital unless I call someone from church. Obviously, I can think and write so I guess I’m okay but the blackouts are scary. I don’t know what to do. Sometimes my family makes me feel like I am too ‘precious’ and navel-gaze too much. They think I should just get on with things and my symptoms will eventually go away. I’m not so sure. I don’t want to be stupid. I don’t know what to do.

I was lying on my side when my partner put a pillow over the right side of my head and punched me there. I felt like my brain separated for 2 seconds then the pain hit. Two weeks later, still having headaches. Do I wait it out?

Hello, my mom fell in the grocery store. She hit the whole left side of her body. 2 weeks later. She’s feeling dizzy with a constant headache, nauseous, and has eye pain or her left side. Should she go to the hospital?

I’m sister was in an MVA contusion to left side of head. Diagnosed with concussion at hospital , had clear CT. Week later swelling in right side base few inches behind ear. Pain behind right eye. Swelling went from small swollen bump to area? Is this related?

i got slammed in the head when someone opened the door really hard. It hurt a lot but no bruise right away. i had a stomache ache that day and went straight home and slept. The next day it really hurt and i had a headache. I felt a bit nautious and dizzy but i am unsure if if it was because of that or my stomache. I put ice and it felt better. today i don't have a headache or feel particulary nautious, it also doesn't hurt as much. Should i still go to the doctors?

When in doubt go to hospital. ..its better to be safe then sorry! !!!hope you went!!!and all is well, God bless you!!!

Hi I fell down and I hit my head on a door next to me. I lost consciousness for like only a couple seconds and had a shooting pain through the back of my head. I started crying because this NEVER had happened to me before so I freaked out a little. I didn’t get any swelling on my head, but it does feel kinda bruised. My husband checked my blood pressure and said it was normal and I was probably just dehydrated and tired. (I don’t drink a lot of water nor sleep well.) At the moment I’m on vacation so I don’t have the ability to go to my primary care doctor for another month. My husband convinced me that I don’t have to go to the hospital, but I don’t know what to do at the moment to be honest. What should I do in the mean time, put ice on my head?

Definitely if you lost consciousness you should go to the doctor. that's a sign of something super serious. rather it may just be a concussion or something else.

I've never had a concussion before in my life even when I was in cheer and soccer but yesterday at work (I work with pizza and I had absolutely no traction on my shoes) I was kinda jogging and made a turn too fast and slammed my head on the floor and landed on my side ever since then I've had a None stop headache and I slept for 12 hours straight and I've felt nauseated, there no bump or bruise then but my husband checked today and there is a soft bump and a little bruising on my head and the side of my arm that I landed on. It feels a little bit better when I take Tylenol but I'm still having headaches and a little dizzy and ive started shaking..

sounds like a hell of a concussion to me

About 3 days ago I was showering and I accidentally hit the back of my head really hard with the soap holder, I felt everything move inside my head so I quickly kneeled down to rest. I thought I was bleeding but luckily I wasn’t. I’ve had bad headaches ever since, and the sides of my head really hurt sometimes out of the nowhere. My jaw also started hurting that day, it hurt to eat. I felt nauseous the day of and the day after, now it’s just sometimes. I just feel tired now and then but my headache comes and goes. Should I just wait a couple of more days to see if the symptoms go away?

I hit my head today on the cabinet corner pretty hard and I cried and I never cry with pain. I even didn’t cry when I broke my neck. But I’ve had a headache all day in the area and been dizzy on and off. It’s sensitive to the touch, no swelling though. I haven’t been able to eat at all since I hit my head today, I just have no desire to eat and I’m nauseated. Should I go to the hospital tonight for it?

5 days ago I fell in my yard, trip over a chair and hit the side of my head. The next day my skull was very tender to the touch where I fell. Just had a headache, but on the fourth day I have a black eye. should I go to the ER? just still having headaches.

In the article above the doctor mentions that headache is a symptom of concussion. Maybe give your primary care doc a call and see what they say?

I have epilepsy and had a grand mal. Fell in the garage and obviously hit my head. I usually always have a migraine with nausea following a seizure, and take meds as needed after a seizure. This time, I hit my head obviously quite hard. I had a goose egg swelling on the upper left back side of my head. No one witnessed the seizure. I actually didn’t feel bad quite as long as usual and my VNS was recently increased. It helps me recover faster. Anyway the goose egg remained, a few hours later it was time for bed and the area was sore. When I felt the area, there was swelling around the area where there was a knot but an indentation in the center. My husband came home after I regained consciousness and could get to my phone. Pupil dilation is normal. Cognitive, I mostly seem ok. I was concerned more because when I laid down to sleep had vertigo and still feel dizzy. Vision doesn’t seem affected.

Seems a good idea to seek medical attention -- at least reach out to your primary care doc!

I hit my the side of my face and head really hard falling over a small fence, I had a drink at the time but the next my check was really sore and my head, this was three days ago and I feel a bit fuzzy headed and my tinnitus has got worse, I'm sure if I should go hospital or not. I am able to drive etc.. But not sure if I'm panicking for nothing

When in doubt, get it checked out! Place a call to your primary care doctor's office and see what they say

i got hit with a wooden paddle on my forehead playing ping pong in gym. it hurt and i didn’t feel good i didn’t black out or anything it just hurt really bad it put a little knot on my forehead i have headaches since then and that was a day ago.. should i be concerned?

I got hit with a football on the head 4 weeks ago and it still hurts but just down 1 side should I be worried

Hi LaShea, It would probably be a good idea to at least go see your doctor.

I banged the left side of my head behind my ear on a rock, i started to see black spots then i just dropped and people around me said i was on the floor for a little bit they thought i was dead and so then i turned yellow and pale and my lips were purple and my eyes... i don’t know if it was just dehydration but a couple months ago i had a kidney half taken out since it had a tumor pressing on the renal artery to my heart it’s now the 2nd day my ear and head keep hurting only on the side where i hit it..i definitely should’ve went to the hospital but i was telling everyone i was okay and i went in the shade i regained my color and full consciousness. Should i be concerned ?

Hello, I fell and injured my head and neck and my whole left side. Did not brake any bones. I was at McDonalds and the flood was wet with soda. I was very careful. My shoe must had been wet and in the air I went. I had a sprain neck and now need surgery. Had a level 3 concussion. This was 10 months ago. My neurologist says I have concussive syndrome. The last four days my my head is hurting bad. It feels like it is full of pressure. I can’t bend my head over. If I do it hurts bad. Can you help? Do I need to go to the ER?

I would definitely go to the doctor. I hope you are okay. What is concussive syndrome? Are few days ago I was drunk and did a pull up on a light post thing (not very high) and just bonked my head on a jut (about 2 inches in diameter) in the post hanging down. My head doesn't hurt too bad, but the top of my head was sore yesterday, and it kind of feels cloudy today, so I hope I am not letting it go untreated if it needs to be, but I feel like personally in my case it was minor? It really only barely hurts to the touch, but maybe there could be a minor injury even though I didn't black out.

4 days ago I was in my office and got up to get some folders from the floor beside my desk. My depth perception must've been off, because as I bent down (rather quickly) I smacked the front of my forehead (by my hairline) really hard. My teeth seemed to shake & my eyes went funny for a second, both I'd expect from a hard hit...the area is still tender to the touch, no bruising, but headaches all 4 days since. My oldest daughter has had 5 soccer related concussions. I feel I know my way around them, & don't believe I had one. Generally how long will this headache & tenderness last? No vomiting, no loc, just some nausea & the headache. I feel crummy...not big on going to the ER for Anything. Never taken seriously.

Feeling dazed, headache and nausea are ALL symptoms of concussion. If you're not feeling up for the ER, then at least call your primary care physician and run how you're feeling by them.

Last night a heavy glass figure fell off fridge and busted my head open, I have headache and the injury feels it is going down backnif neck. Is this normal? I did not pass out.

A headache after a head injury is one of the symptoms listed above that the doctor suggests getting medical attention for.

I was boarded against the glass in hockey, went down and saw stars, did not pass out. Head hurt for a day or two. This was 2 weeks ago. This past weekend was in a tournament, jumped up to grab puck came down and my skates came out from under me and head hit ice. Just stars again, I did not black out. I have persistent headaches (through out my whole head) and nauseated. Sometimes I have forgotten what I was doing. I have been sleeping but figured from tylenol..thoughts???

Feeling dazed and confused, headaches, and nausea after a head injury are all symptoms of concussion. You should definitely get medical attention. Especially considering that you've had two injuries in just the last couple of weeks. There should also be concussion protocol in place for you team?!

I passed out a few days ago. I fell in my driveway which is mostly dirt and rocks. I fell on my back hitting the back of my head on the ground. I woke up and got to my front door before passing out again. I didn’t feel pain until the day after and still today. I’ve had a headache since and neck pain and stiffness. My back hurt for a day or two but not as much. Should I be concerned about my head or neck?

Hello, I fell in the bathroom knocked my back head on the wall.. No pain until 2 days after, now having on n off headache from the back of my head, my BP rose (170 n something) though v hypertension before now. I v bn taking Naproxen sodium 275mg since yesterday but getting temporary relief. Do I need to go to hospital or not?
Thanks

Absolutely need to go by the sounds of it. Even to get checked out. Better to be safe than sorry or worse.

I was in a hurry I hit my head on the acrylic sinks I refused to go to the ER my family told me I was Dazed and Confused trying to go to sleep the bathroom is between kitchen and in my room nice shoes went to my room my glasses went into the kitchen it left a knot on my hand now it's been 2 Days Later and it still hurts I'm having headaches everyday since then and yes I did throw up couple times after it happened but it's been a couple days now and when I open my left eye and shut my right eye I have blurred vision but when I close my left eye I can see very very good from my right eye and I've been keeping my left eye closed

Both vomiting and "feeling dazed or confused" are listed above as reasons to promptly go to the ER. Considering it's been days and you still feel bad, you should probably seek medical attention. At least call your primary care physician.

My face slammed into a pole at work two days ago, Monday around 1 pm. Split my eyebrow open, black eye and cheek swollen and bruised.
Two days later I'm feeling nauseas, headachy, and swollen worse.

I had a broken gas powered weed eater in the shed. Up about three feet, motor side down. The head of it is broken off. It fell over, the round pole part hitting me in the left temple. It hurt bad but no loc or vomiting. Just a quarter sized slightly raised swelling lump and slight bruising and small scrape. Had a headache earlier before it happened and had taken OTC migraine meds that relieved it. Headache came back immediately and is still there. My son had a chemo treatment yesterday so I don't want to go to ER if it's not necessary.

How are you? Did you get a response. Usually outward swelling is a better sign. Headache can be an issue. Did it knock you out?

I stepped on the end of a rake and the other end hit me in the left front forehead. I have a large bump that has gone down from when it happened yesterday at 3pm. I am also a panic attack person, so I am not sure if my reaction is from the bump or panic anxiety: never passed out, naseauted, etc . Should I be concerned? it’s a concussion or anxiety

I fell and hit the back of my very hard on wood flooring. I just have a headache and big bump on the back of my head. I had a meningioma resection 17yrs ago. Should I go ER and be checked out because of my former surgery!

Yesterday I fell riding a hover board on the road I hit hard first my tailbone then my head slammed back at first I thought I was good but now slight neck movements hurt and I can't lay my head down it has to be in the side. I'm 14 so what should I do?

You probably sprained some of your neck muscles or pulled one. It should get better in about a week if that's all that it is. If you have any naseua or amnesia you should go to the doctor.

Hello,
Back in 2006 I was a patient at Cabrini Hospital in New York City and I was given the medication Clozeril for schizophrenia which made me feel like I was hit in the back of the head by a two-by-four (twice). The caused me to have severe lapse in judgement not to mention the pain that I was in.
I have not fully recovered from this but was wondering if you knew of anyone else who has been through the same thing as I have?
I'm currently on Wellbutrin (but more for quitting smoking than anything else) yet am still very psychotic)
Any thoughts on what I have written?

A glass plaque fell on my daughter’s head st school. She says she’s fine but her head hurts. Should I take her to the hospital. She has sports practice in an hour and I’m not sure I should take her. Thank you.

My 11 year old banged her forehead on a desk it wasn't bleeding but she got a headache and her back started hurting she was also extremely cold what should I do

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?

I would get this checked! Go to the ER or doctors

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?

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