Head injury | Wharanga ūpoko

The term head injury (wharanga ūpoko) includes both visible injuries to the scalp and internal injuries to the brain.

Key points  

  1. Always get a head injury checked by a doctor if it was caused by a hard bang, causes loss of consciousness or concussion, or if you are concerned about any other physical or mental symptoms.
  2. Injuries to your head should always be treated seriously as there may be damage to your brain. If not treated properly, permanent and, often, preventable brain damage can occur. 
  3. In some cases, signs of brain injury may be delayed for 24 to 48 hours due to a gradual increase in swelling or bruising around your brain.
  4. If the head injury is minor with no worrying symptoms, see our self-care tips for caring for someone at home.
  5. Seek urgent medical help if the person with a head injury develops a severe headache, starts vomiting or shows signs of mood swings, unusual tiredness, concentration problems or behavioural changes or any of the red flags in the table below.

Head injuries can happen in many different ways

This includes:

  • being hit on the head
  • sporting injuries
  • car or bike accidents
  • falls around the home (especially for toddlers and older people)
  • falls from heights
  • speed-related blows to the head.

When to see a doctor about head injuries

If someone is unconscious or unable to move all or some of their limbs or is complaining of neck pain:

  • call 111 immediately
  • don’t move the person (unless it’s dangerous to leave them where they are).

Get medical help urgently if you or someone you are caring for:

  • has received a hard bang on the head (say, from a major fall)
  • appears dazed or loses consciousness, even momentarily
  • seems unwell or vomits after the injury or show any of the warning signs in the table below.
Warning signs – the following symptoms need immediate medical attention:
• Complaints of neck pain
• Increasing confusion or irritability
• Repeated vomiting
• Seizure or convulsion
• Double vision
• Muscle weakness, tingling or burning in arms or legs
• Deteriorating conscious state
• Severe or increasing headache
• Unusual behaviour change
See also: ACC SportSmart National Concussion Guidelines

Delayed symptoms after a head injury

After someone experiences a head injury, there may be no immediate symptoms – no loss of consciousness and no signs of injury on your head or face. However, you need to monitor anyone who has had a head injury, as symptoms may develop later.

Signs to watch for:

  • loss of consciousness – being 'knocked out'
  • seizure
  • vomiting
  • trouble recognising people or places
  • decreasing consciousness
  • increasing sleepiness
  • neck pain
  • weakness in arms or legs
  • slurred speech
  • leaking fluid from the nose or an ear
  • physical signs of injury requiring medical attention
  • symptoms getting worse.

Anyone who knocks their head (playing sport or in a fight or accident) and gets up straight away, still needs to be closely watched. If they show any of the warning signs in the table above, they should see a doctor immediately. 

Likewise, anyone who is knocked out (is unconscious and can't be woken up, even if only for a minute or so) needs to see a doctor urgently to exclude a skull fracture or serious brain injury.

Call Healthline free on 0800 611 116 if you feel at all uneasy about an injury or are unsure what to do.

Self-care after a head injury

If you or a family member has a minor head injury with no worrying symptoms, try these ideas. If you have any concerns at all, see your doctor.

  • Apply ice or a cool pack for 10 to 20 minutes, every 2 to 4 hours, for the next day or two. (Wrapped ice or a pack of frozen vegetables will work well.) This will reduce swelling of the scalp and help with the pain.
  • Drink only clear fluids for the first 2 hours, to reduce the chance of vomiting.
  • Take nothing stronger than paracetamol for pain.
  • Rest – someone must stay with the injured person if they sleep.
  • Check every 2 hours to see if the person wakes easily (if asleep) and responds normally. Check that their behaviour and movements are normal and that they know who they are and where they are.
  • A responsible person should stay with the person for 48 hours after the injury.
  • The injured person shouldn’t drink any alcohol for 24 hours.

Also see: Concussion 

Learn more

Head injury Ministry of Health, NZ, 2018
First aid for head injuries St John, NZ
Head injury – first aid Medline Plus, US, 2019

Dr Stephen Kara

Stephen works with Axis Sports Medicine Specialists in their dedicated sports concussion clinic. His interest in concussion was generated from 15 years involvement in provincial and national rugby and has led to an education role with NZ rugby for community-based rugby and referees. 

Stephen is a subject matter expert in concussion and head injury.
Credits: Health Navigator Editorial Team. Reviewed By: Dr Stephen Kara, MBChB, FRNZCGP, Dip Sports Med, Dip Obs, MPhil (Hons) Last reviewed: 29 May 2019