I Just Hit My Head Really Hard. When Should I Freak Out?

Vanessa Etienne, Colleen de Bellefonds
·9-min read
Photo credit: Getty Images
Photo credit: Getty Images

From Men's Health

Heading the ball during a soccer game, completing a “normal” tackle in a football game, or even bumping your head as you get into the car might seem like NBD. But if you’re dizzy and a bit disoriented and hope to just “shake it off” and carry on, you might be making a big mistake.

About 2.5 million Americans visit the ER every year for a head injury, according to the CDC, with around 10 percent requiring hospitalization. Men are around four times as likely to injure their noggin as women, with alcohol involved in about half of cases, according to Harvard Medical School. Common causes for injuries include falls and vehicular accidents.

“As humans, we hit our heads a lot. Our skull is purportedly developed to resist injuries. Not all the hits are relevant. We typically do not have consequences,” says Mayo Clinic neurologist Rodolfo Savica, M.D. But while permanent damage is not very common, it can still happen.

What is a concussion and what are the risks?

A concussion is a mild traumatic brain injury that causes temporary brain dysfunction (i.e., concussion symptoms—more on that later) that almost always goes away with time. A blow or jolt to the head causes rapid movement of the brain inside the skull, leading to changes in how the brain works. The word comes from the Latin words “concutere,” which means “to shake violently” or “concussus,” which means “the action of striking together,” Savica explains.

According to the UPMC Sports Medicine Concussion Program, five of 10 concussions go unreported or undetected. “Head injuries of clinical significance, even minor ones, are relatively common,” says Edward Benzel, M.D., a neurosurgeon with the Cleveland Clinic. “People may not have realized they had a concussion. Or players will hide injuries from their coach.”

While the risks of a single concussion are trivial, a large portion of severe brain injuries today are caused by an unidentified or improperly managed concussion, Benzel says, since serious problems can arise if it recurs. “Five or 10 minutes after having a concussion a player will feel fine and go back out—and then get bonked again,” he says.

So, how do you protect yourself? Here’s a checklist to follow if you hit your head really hard:

Consider what happened

Yes, a significant blow to the head or other serious injuries can lead to a concussion, but don’t count out any minor incidents. Repeat injuries or multiple small bumps to the head can be just as harmful as a single injury, according to the Concussion Legacy Foundation. If you feel like you’ve significantly bonked your head, or if people around you observed alarming impact, it’s a good idea to get yourself checked out for a potential concussion. If you experienced a minor hit, it’s beneficial to rest afterwards to avoid any further impact. If repeat minor hits occur, don’t hesitate to visit a doctor.

Keep in mind that how you hurt yourself doesn’t necessarily correlate to the severity of your injury. “A not uncommon cause of severe brain injury is a person falling off a bar stool in a tavern because they’re drunk. They only fall 3 feet, but they hit their head on the floor, resulting in severe brain injury or even death,” Benzel says.

Look for the symptoms of a concussion

Concussion symptoms aren’t always totally obvious, and they often don’t last long. “Sometimes early after a concussion people stumble and may not be thinking clearly or may not remember the last play. It usually resolves very quickly but deserves complete removal from the chance of having another injury,” Benzel says.

Symptoms of a concussion include:

  • Loss of consciousness

  • Loss of coordination or balance

  • Dizziness

  • Changes in eyesight

  • Nausea and/or vomiting

  • Difficulty concentrating

  • Confusion

  • Problems understanding or speaking

  • Difficulty reading or writing

  • Memory problems

  • Headache

  • Weakness

  • Altered behavior, including irritability

  • Seizures

If you experience any concussion symptoms—even if they’re minor or short-lived—it’s a good idea to see a doctor for diagnosis and to be observed for a few hours until you’re back to your normal self.

“Generally speaking, it is better to immediately search for medical attention, especially when the head trauma is associated with loss of consciousness” or when it’s followed by other concussion symptoms, says Savica.

Watch and wait for a few hours

If concussion symptoms persist over the following few hours or get worse, get to a doctor as soon as possible. “It could be a sign of something evolving, like a blood clot in the brain, which is very uncommon but does occur,” Benzel says.

Keep in mind that sometimes concussion symptoms can appear six or seven hours after an accident if you have what Benzel calls a sub-concussive blow. Again, head to the ER. “It could be a more serious injury than they may have thought,” says Benzel.

Check for signs of a more serious injury

Very rarely, a serious whack to the head can result in a skull fracture causing potentially deadly bleeding (hemorrhage) and/or a blood clot (epidural or subdural hematoma). You’ll pretty much always get diagnosed initially with a concussion. Benzel recommends always double-checking for symptoms including:

  • Clear fluid or blood coming from the ears or nose: Bleeding at the site of impact is often a simple cut, but fluid from your ears or nose could be spinal fluid

  • Bruising behind the ears or around the eyes: While bruising from a bump to your forehead is often nothing more than a goose egg, bruising behind the ear or around the eyes can be a sign of internal bleeding (hemorrhage)

  • Weakness on the opposite side of the body: In addition to a worsening confusion or memory problems, weakness opposite where the injury occurred can indicate a hematoma

With an epidural hematoma, or a blood clot just under the skull, you’ll likely wake up from your concussion and might even feel like you’ve recovered, Benzel explains. However, a tear in a vein slowly causes a blood clot to form over the next minutes to hours, leading to progressive neurological deficits that can result in coma or death. It’s sometimes called “talk and die” syndrome, because “once a year in American football a player is hit early in the game and isn’t diagnosed as having a concussion. They get hit again, get up again, talk, and die,” Benzel says.

While epidural hematomas are relatively uncommon, especially in sports, Benzel notes there have been several incidents. In 1920, for example, Cleveland Indians shortstop Ray Chapman was hit by a pitched ball, stood up woozily, collapsed of a concussion, recovered enough to continue to play, and then died within hours. “That’s why short-term observation is critical,” Benzel says.

A subdural hematoma, or a blood clot on the brain itself, is another relatively uncommon injury to the brain that’s usually caused by a car or motorcycle accident or a serious fall. The resulting concussion would knock someone out for the count and then quickly lead to devastating consequences within minutes to an hour because severe bleeding comes from an artery.

Both types of hematomas usually make themselves known with symptoms right away. However a mild head injury in elderly people can cause an initially symptomless chronic subdural hematoma that worsens over a few weeks as the clot expands. “This occurs in the elderly because the brain shrinks as you age, so you’re more exposed to shaking and jostling with trauma. Vessels can rupture. They might bleed just a little bit, and a little bit later, until it accumulates and they need some type of procedure,” Benzel says.

Be cautious for the next couple of weeks

Following an injury, continue to look out for symptoms of a concussion for the next few weeks to ensure you are fully healed. That goes even if you hit your head hard but didn’t think you had a concussion, because it’s possible to have a brain injury and not know it. “Usually concussion does not cause major symptoms, and some symptoms can appear days to weeks after the trauma. Likewise hematoma can be silent and occur without clear initial symptoms,” says Savica.

And if you were diagnosed with a concussion, follow up with your doctor as recommended, usually about one week later. It’s essential to wait until your symptoms are completely gone and you’ve been cleared by an expert to go back to any activities like team sports where you might hit your head again, which can add on to the potential damage and make your injuries significantly worse. “Even seemingly minor symptoms are risk factors,” Benzel says. “The idea is to allow the injury to completely heal before the person is exposed to any more high impacts.

How to manage a concussion

Get a concussion test before a possible injury occurs. Concussion tests assess your brain function both before and after trauma to the head. Doctors or other medical professionals evaluate skills like balance, memory, concentration, and response time. This serves as a baseline to compare if you are later injured in order to diagnose a concussion. There’s also now a science-tested rapid concussion test, produced by Abbott, for evaluating mild traumatic brain injury (TBI). The test, cleared by the FDA, requires a small blood sample from the arm which is analyzed for specific proteins that are present after a TBI. Results are available within 15 minutes.

"Evaluating brain injuries is complex – and research shows that we only catch about half of those who show up to the hospital with a suspected TBI," said Geoffrey Manley, M.D., Ph.D., vice chair of neurological surgery at the University of California, San Francisco in a press release. "A test like this could encourage more people to get tested after a head trauma, which is important, because not receiving a diagnosis can be dangerous and may prevent people from taking the necessary steps to recover safely."

And those next steps are crucial. Once you have been diagnosed with a concussion, both physical and mental rest are necessary in order to heal. The CDC suggests limiting activities that require high mental concentration, and following these tips for a speedy recovery:

  • Get plenty of sleep

  • Limit screen time and other activities that could cause eyestrain

  • Avoid physically demanding activities or recreational sports

  • Don’t drink alcoholic beverages

  • Talk to your employer about adjusting your work schedule

  • Ease back into normal activities one by one

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