I Bumped My Head- Now What?

The recent death of famed pitchman Billy Mays was tragic (he convinced me to spend $19.95 for not one, not two, but six tubes of "Mighty Putty"). He apparently died from heart disease, but initial speculation blamed his death on a head injury he suffered during a rough airplane landing the night before. While the head trauma seemingly did not cause Billy May's death, it raises the question: what worrisome signs should I be looking for if I bump my head?

Bleeding in the Brain

Head injuries can be lethal from something called a hematoma. A hematoma develops when there is bleeding in the brain. There are two main types: epidural and subdural. The brain is surrounded by a tough layer of tissue called the dura. When the skull suffers an impact blow, the brain shifts and collides with the skull, causing shock to the tissues. This is known as a concussion. Depending on the severity of the blow, concussions range from mild (with symptoms lasting only a few hours) to severe (confusion, nausea and headache lasting for days). Most concussions are not deadly, but bleeding in the brain can be.
An epidural hematoma is a collection blood that develops between the outer skull and the dura layer. This type tends to develop quickly and can be deadly within hours. Actress Natasha Richardson died of this type of hematoma, which she suffered during a skiing accident. Symptoms include severe headache, vomiting, a sudden change in vision, profound lethargy, and confusion. An epidural hematoma will show up on a CT scan of the head within minutes of the injury. Brain surgery must be performed within hours to removed the blood and stop the building pressure from killing brain tissue.
A subdural hematoma occurs beneath the dura, between the dura and the brain. It tends to develop more slowly. In fact, someone with a subdural hematoma may not show symptoms until days after the initial injury. A CT scan performed within minutes or hours of the injury may be normal. The symptoms are the same as with the epidural: severe headache, vomiting, a sudden change in vision, profound lethargy, and confusion.
What to Watch For
If you suffer a head injury, seek medical attention immediately if you have the following symptoms:
- Severe headache that does not get better with acetaminophen (Tylenol) or ibuprofen (Motrin/Advil)
- Vomiting (especially if it is what we call "projectile" vomiting- when it is very forceful)
- Blurry or double vision. Some concussions, which are not life-threatening, can produce mild blurriness for a few hours. If the blurriness is severe or does not resolve within a few hours, seek medical attention.
- Irregular pupils. If the pupils are different sizes, you need to be evaluated.
- Extreme drowsiness. Many concussions produce a "tired" feeling. However, if all you want to do is go to sleep, and people around you can get you to rouse or wake, they need to take you to the ER. It is also advisable during the first 24 hours following a head injury to have someone wake you every 2-3 hours, just enough to rouse you. If they can't wake you at all, it's time to visit the ER.
- Confusion. This is a major red flag. If you are saying oddball things (more than usual), confused about time or place, or just babbling nonsense, this likely indicates a serious problem.
Lastly, a word about prevention. Wear a helmet when biking, rollerblading, riding a motorcycle, or playing contact sports. It is well worth the trouble.