This leaflet gives guidance to help recognise symptoms following a head injury including information on what to do if someone has had a possible head injury after an unwitnessed fall. You should always contact a doctor or nurse if you have concerns after a head injury and if the condition of the injured person changes.
Minor head injuries
Minor head injury and knocks to the head are common, if the injured person is conscious (awake), and there is no sign of damage it is unusual that there would be any damage to the brain. However, sometimes a knock to the head can cause damage to the brain or to a blood vessel next to the brain. A damaged blood vessel may bleed into the brain, or more usually, into the area between the brain and the skull (a 'subdural haemorrhage'). This is uncommon, but can be serious as a build-up of clotting blood can cause pressure on the brain. Symptoms of damage or bleeding may not develop for some hours, or even days after a knock to the head. In rare cases, symptoms from a slow bleed can develop weeks after a head injury.
You should contact a doctor quickly if you notice any of the following symptoms :
 drowsiness when they would normally be wide awake
 worsening headache
 confusion, strange behaviour, any problems understanding or speaking
 vomiting
 loss of use of part of the body e.g. weakness in an arm or leg
 dizziness, loss of balance or convulsions
 any visual problems, such as blurring of vision or double vision
 blood, or clear fluid, leaking from the nose or ear
 new deafness in one or both ears
 unusual breathing patterns
Drowsiness means someone cannot be roused (woken up)
After a knock to the head, it is not uncommon to want to sleep for a short while. This is normal (especially in children). However, sleep should be normal and 'peaceful', the injured person should wake up fully after.

If the injury/unwitnessed fall happen just before bedtime, it is still all right to go to bed as normal. If you are worried about someone who has had a head injury or unwitnessed fall, consider waking them up after an hour or so. They may be grumpy about being woken up, but this is reassuring and you can let them go back to sleep. This can be done a few times during the night if you are particularly worried. When asleep, make sure they are sleeping in a normal position and breathing normally.
A headache that continues to become worse is of most concern. Always contact a doctor or nurse if you are worried about such a headache after a known or suspected head injury
It is normal after a knock to the head to have a mild headache. There may also be tenderness over bruising or mild swelling of the scalp. Paracetamol or Ibuprofen may help, unless otherwise instructed by a doctor.
Other symptoms that may occur
Mild symptoms may develop after a head injury that are not serious and go away within two weeks. These can include a mild headache, feeling sick
(without vomiting), being irritable and grumpy, tiredness, poor appetite and difficulty concentrating. These may be just as a reaction to a knock on the head and not due to bleeding or serious injury. If you have any doubt about symptoms following a head injury then it is best to get them checked out by a doctor as soon as possible. If there has not been a complete recovery after two weeks, it would be sensible to be reviewed by a doctor
Tips and general advice
If possible, the injured person should not be left alone for the first 48 hours.
Alcohol should be avoided for the next few days and avoid sleeping tablets or sedatives unless prescribed by a doctor. Driving, riding a bike and the use of machinery should be also be avoided until completely recovered.
Please bring this leaflet to the attention of any care staff or relatives who may be looking after the injured person, so they know what symptoms to look out for.
Falls Steering Group November 2012
Review November 2014