Head Injuries: Causes and Treatments  

Head injuries are dangerous. They can lead to permanent disability, mental impairment, and even death. To most people, head injuries are considered an acceptable risk when engaging in sports and other types of recreational activities. But there are steps you can take to lower the risk and protect yourself and your children.

Head injuries are injuries to the scalp, skull, or brain caused by trauma. Concussions are the most common type of sports-related brain injury with an estimated 1.6 million to 3.8 million sports-related concussions a year. A concussion is a type of traumatic brain injury (TBI) that happens when the brain is jarred or shaken hard enough to bounce against the skull. This can happen when two athletes collide or when someone falls and hits his or her head. It can also result from being hit in the head with a piece of sporting equipment. In a sport such as soccer, even “heading” the ball can cause a concussion. A concussion causes an alteration of a person’s mental status and can disrupt the normal functioning of the brain. Multiple concussions can have a long-lasting, cumulative life-changing effect.

You don’t have to be hit in the head to experience a concussion. An impact elsewhere on the body can create enough force to jar the brain. You also won’t necessarily lose consciousness with a concussion. Concussions range from mild to severe. The effects may be apparent immediately, or they may not show up until hours or even days later.

Other types of TBIs are a contusion, which is a bruise on the brain that can cause swelling, and a hematoma, which is bleeding in the brain that collects and forms a clot. A skull fracture is another type of head injury that can affect the brain. Sometimes with a fracture, pieces of bone can cut into the brain and cause bleeding and other types of injury.

In 2008, the following activities resulted in the highest number of head injuries for all ages:

• Cycling
• Football
• Basketball
• Baseball and softball
• Riding powered recreational vehicles such as dune buggies, go-carts, and mini bikes

According to the Brain Injury Association of America, the five leading activities responsible for concussions in children and adolescents aged 5 to 18 years of age are:

• Cycling
• Football
• Basketball
• Playground activities
• Soccer

Signs of a TBI include:

• Confusion
• Depression
• Dizziness or balance problems
• Double or fuzzy vision
• Feeling foggy or groggy
• Feeling sluggish or tired
• Headache
• Memory loss
• Nausea
• Sensitivity to light or noise
• Sleep disturbance
• Trouble concentrating
• Trouble remembering

Indications that a head injury is more serious than a concussion and requires emergency treatment include:

• Changes in size of pupils
• Clear or bloody fluid draining from the nose, mouth, or ears
• Convulsions
• Distorted facial features
• Facial bruising
• Fracture in the skull or face
• Impaired hearing, smell, taste, or vision
• Inability to move one or more limbs
• Irritability
• Lightheadedness
• Loss of consciousness
• Low breathing rate
• Restlessness, clumsiness, or lack of coordination
• Severe headache
• Slurred speech or blurred vision
• Stiff neck or vomiting
• Sudden worsening of symptoms after initial improvement
• Swelling at the site of the injury
• Persistent vomiting

If you think you may have a concussion or suspect that someone else has one, the most important step to take is to prevent further injury. Stop whatever activity you are involved in and tell someone you think you may have been injured. Then get medical attention. If you’re playing as part of a team, ask to be taken out of the game and tell the coach what happened. If a fellow player has signs of being confused or a sudden loss of coordination, be sure to report this to a coach. If you are coaching a team and you notice a potential injury, take the person out of the game, and see that the person gets medical care.

Receiving medical attention as soon as possible is important for any type of potentially moderate to severe TBI. Undiagnosed injuries that don’t receive proper care can cause long-term disability and impairment. Keep in mind that although death from a sports injury is rare, brain injuries are the leading cause of sports-related deaths.

Symptoms should be closely monitored often with a moderate to severe injury and may require an overnight stay in the hospital. X-rays may be used to check for potential skull fracture and stability of the spine. In some cases the doctor may ask for a CT scan or an MRI to check on the extent of the damage that occurred. More severe injuries may require surgery to relieve pressure from swelling.

If the doctor sends you home with an injured person, the doctor will instruct you to watch that person closely. That may involve waking the person every few hours to ask questions such as “What’s your name?” or “Where are you?” to be sure the person is OK. Be sure you’ve asked the doctor and understand what symptoms to watch for and, which ones require immediate attention.

Guidelines urge doctors to be conservative in treating sports-related brain injuries and to not allow someone who has been injured to return to activity that involves risk of further injury until completely free of symptoms. That usually takes a few weeks. But symptoms of severe injury could persist for months or even years. A person with a moderate to severe injury will likely require rehabilitation that may include physical and occupational therapy, speech and language therapy, medication, psychological counseling, and social support.

The most important step to take is to buy and properly use protective head gear that has been approved by the American Society for Testing and Materials (ASTM). Be sure to buy the right size for a proper fit and to wear the helmet or headgear properly. According to the American Association of Neurological Surgeons, helmets or headgear should be worn at all times for the following activities:

• Baseball and softball
• Cycling
• Football
• Hockey
• Horseback riding
• Riding powered recreational vehicles
• Skateboarding and riding scooters
• Skiing
• Snowboarding
• Wrestling

Other important safety measures include:

• Wear light-reflecting clothes when riding a bike at night.
• Don’t dive in water less than 12 feet deep or any body of water where you cannot see the bottom, murky water.
• Make sure that children’s play areas and equipment are safe and in good repair.
• Don’t let children play sports that are inappropriate for their age.
• Supervise and teach children how to properly use sports equipment.
• Don’t wear clothing that interferes with vision.
• Follow all rules at water parks and swimming pools.
• Don’t skateboard or cycle on uneven or unpaved surfaces.
• Don’t play sports when you are tired or very ill.