Head injury ranges from mild concussion to severe traumatic brain injury and represents a critical emergency presentation. Even injuries that initially appear minor can conceal serious internal bleeding, skull fractures, or brain swelling. Early recognition, structured evaluation, and continuous monitoring are essential to prevent permanent neurological damage or life-threatening complications.

Head injuries may result from road traffic accidents, falls, sports injuries, assaults, or blunt trauma. Patients may present with headache, dizziness, nausea, vomiting, confusion, blurred vision, memory loss, or temporary loss of consciousness. Severe injuries may involve seizures, unequal pupils, altered mental status, or focal neurological deficits. Because symptoms can evolve over time, careful observation is required.

Emergency evaluation begins with stabilization of airway, breathing, and circulation, particularly in patients with decreased consciousness. Oxygen saturation and blood pressure are monitored closely, as low oxygen or hypotension can worsen brain injury. A structured neurological assessment evaluates level of consciousness, pupil size and reactivity, limb strength, speech, and orientation.

Imaging studies, typically a CT scan of the brain, are performed when indicated to detect bleeding, skull fractures, brain contusions, or swelling. Timely imaging is crucial for identifying conditions such as intracranial hemorrhage or epidural hematoma, which may require urgent neurosurgical intervention.

Concussion, a mild form of traumatic brain injury, may not show visible abnormalities on imaging but still requires careful assessment. Symptoms can include headache, light sensitivity, difficulty concentrating, irritability, and sleep disturbances. Patients with concussion are monitored for worsening symptoms and educated about warning signs that require urgent reevaluation.

Severe head injuries may require neurosurgical consultation and intensive care monitoring. Continuous neurological reassessment is performed to detect changes in mental status or neurological deficits. Elevation of intracranial pressure is a serious complication that requires rapid intervention.

Risk factors such as anticoagulant use, advanced age, or high-impact trauma increase the likelihood of serious complications. Patients taking blood thinners require particularly careful evaluation due to increased bleeding risk.

Observation periods vary depending on severity. Patients discharged after mild injury receive clear instructions regarding warning symptoms such as persistent vomiting, worsening headache, confusion, drowsiness, or seizures.

Emergency management of head injury prioritizes prevention of secondary brain injury through stabilization, early imaging, and vigilant monitoring. Structured protocols improve outcomes, reduce mortality, and ensure timely intervention when complications arise.