You are here

When to Seek Medical Attention for a Head Injury

Originally published in March 2009

In the wake of the tragic passing of actress Natasha Richardson, I'd like to share a few details on head injuries that everyone should know about.

Based on what I've read in several newspaper reports, Natasha Richardson died from an epidural hematoma, which medical professionals will tell you is one of the most frightening conditions around because it can be caused by a low force blow to the head, and also because initially, there may be no signs to indicate that a serious injury has occurred.

Understanding Epidural Hematomas

Your brain is surrounded by three thin layers of connective tissue that are collectively called your meninges. The outermost meningeal layer is called dura mater, and the thin space between your dura mater and the bones that make up your skull is called your epidural space.

Along the sides of your head in the area around your temples, your epidural space houses an artery called your middle meningeal artery, whose job is to provide steady blood supply to your meninges. The portion of skull that protects this area is quite thin and weak compared to the rest of your skull. This is why even a low force blow to this area could lead to a fracture and tearing of your middle meningeal artery.

If your middle meningeal artery was torn or lacerated, blood could quickly begin to pool in your epidural space. Because your heart would continue to send blood to the area and this blood wouldn't be drained by your veins, the net effect of a torn middle meningeal artery would be increased pressure on your brain tissues, which could lead to death of brain cells from oxygen deprivation.

Symptoms and Common Causes of Epidural Hematomas

About 50% of people who experience epidural hematomas briefly lose consciousness, but appear to be just fine when they come to. If pressure in the head continues to build, over a period of a few hours, a searing headache tends to develop as increased intracranial pressure causes the dura mater to tear away from the skull.

Other signs and symptoms that may develop with an epidural hematoma include:

  • Lethargy

  • Nausea

  • Dizziness

  • Drowsiness

  • Weakness on one side of the body

The keys to preventing serious brain damage and death from an epidural hematoma is to recognize what has happened, and for the blood to be aspirated by a neurosurgeon.

I have long recommended that any person who suffers a blow to the side of the head - especially in the temple region - be carefully monitored for any of the signs noted above, and to be ready to visit an ER immediately, accompanied by someone who can explain what has happened.

Common causes of epidural hematomas include:

  • Skiing and snowboarding falls that involve head trauma. According to the American Association of Neurological Surgeons, 1.5 million Americans suffered brain injuries in 2007, and more than 10,000 of these injuries occurred while skiing or snowboarding.

  • Violent blows to the head during physical altercations.

  • Motor vehicle accidents.

Clearly, if you ever take part in an activity where there's a strong chance that you could experience a blow to your head, it's wise to wear a helmet. And there's nothing prissy about making the decision to avoid high risk activities like boxing, high speed skiing, and high level contact sports like football and hockey.

Please note that there are many different forms of internal bleeding that can occur in the skull, and epidural hematomas can arise from tears or lacerations of arteries other than the middle meningeal artery.

Another major type of internal bleeding in the head is a subdural hematoma, where the bleeding occurs below the dura mater. Subdural hematomas are a leading cause of brain injury and death in battered children - direct blows by a care-giver's hand, a child's head being smashed against a hard object, or violent shaking of a small child can all lead to serious injury and death through internal bleeding.

In all cases of head injuries, the warning to heed remains the same: If you suffer a blow to the head, even if you feel fine immediately afterward, stay alert for signs of discomfort and consider being evaluated by a physician if you feel anything out of the ordinary - even a mild headache that comes on after experiencing blunt force to your head should not be ignored.

Please share this information with all parents and grandparents in your life; being aware of this while caring for youngsters is a good thing.


Join more than 80,000 readers worldwide who receive Dr. Ben Kim's free newsletter

Receive simple suggestions to measurably improve your health and mobility, plus alerts on specials and giveaways at our catalogue

Please Rate This

Your rating: None Average: 4.7 (328 votes)
This question is for testing whether you are a human visitor and to prevent automated spam submissions.
Enter the characters shown in the image.


Dr. Kim, thank you for shedding light on this very important issue. There is a silent epidemic of brain injury every year mostly due to the ignorance of the physics of injury. Your article is excellent. I have produced a free video hosted by Google called "The Solution for Brain Injuries and Bankruptcies" which I encourage everyone to view. Sadly after a brain injury hundreds of thousands of people go bankrupt due to medical bills, my video outlines a proven and successful model that has been used in Michigan for 35 years, I am encouraging every other State to adopt this model. Dr. Kim thank you for illuminating the physiology surrounding a brain injury. Parents please insist your children always wear a helmet during any high risk activity, Parents you should too!

Thank you for providing this information!

In December of 2007 I fainted following a flavatomy. I was standing at a counter fell backwards experiencing a severe blow to the back of my head. The fall caused a laceration requiring fourteen stitches or staples. The doctors in the ER stated that there was no internal bleeding (Cat scan). My balance suffered and I went to therapy. My handwriting was degraded severly and it has returned to normal this month 1 1/2 years after the fall. My sense of balance has not recovered fully. In the process of typing I double type r's frequently. I believe that this type of injury cannot be accurately evaluated by standard medical tools. I hope this anecdote is helpful to others suffering similiar falls.

Excellent article, Dr. Kim.
My husband was hit in the head with a baseball 15 months ago.
On the day he came home from coaching I wanted to take him to the hospital, but he refused, so we called his doctor, a friend and community member, who offered the most ridiculous assessment of the situation: "if you didn't pass out, it's not a concussion".
My husband WAS struggling to stay conscious, did see stars, and this presumes a concussion is the only thing to worry about.
We did not go to the hospital, I am sorry to say, and will never ignore my good instincts again. Also, going to the hospital to check checked out provided documentation later needed for insurance claims.

15 months later and my husband is still unable to work in his field - computers. He is overly sensitive to environmental stimulation (we have 4 boys, 3 cats, 2 dogs - very stimulating) and today, for example, has spent half the day in bed recovering from being over-stimmed yesterday!

I am very grateful to Dr. Kim for writing this article and making people aware of the hidden dangers of even mild blows to the head.

Wear helmets!! And be careful! ;-)

While i was visiting my son at school today, a child got badly injured. Some other pupil gave him a quite violent blow on his nose causing quite severe blooding. Due to procedures, the child was only given a tissue paper to stop bleeding emanating from his nose. What can be the consequences of a late treatment? (The child being a 5-6 years old).

In July 2010 my 7 year old son was playing in the creek around 9:00 am at the campground we were staying at. An 11 year old boy was skipping rocks and accidentally hit my son in the left temple region of the head. My son's head did not even bleed. He cried for a few minutes, but said he was fine and wanted to keep playing. He played all day long, riding his bike, and playing a game of baseball. He had not even mentioned his head and we had almost forgotten about it. That evening around 8:00 pm he started complaining of a headache. It got worse and then he violently threw up. We took him to the ER where they did a CT scan and confirmed the large epidural hematoma. Thankfully and miraculously, he still had all of his neurological functions. They did immediate brain surgery and saved his life. We are still in awe of how this seemingly minor injury almost took our son's life. The doctors said we only a few hours left before coma and death. Today he is a happy and perfectly healthy 9 year old. You can never be too careful with any type of head injury. Just because the victim seems fine, does not mean they are.

I am so grateful that you are giving us the gen on head injuries, Dr. Kim. I didn't know anything about sub- or epi-dural hematomas.

Angela, I am glad everything turned out okay and am so glad that you are posting your & your son's story here.

Last month I had a mishap banging my temple area into an attic ladder (sharp corner) as it was hanging half down from the ceiling. I put pressure on my head for bleeding and my friend (who's home it was) taped the laceration shut for me. I took it easy for a few days feeling some slight pulsating pain and pressure off and on in the injury area. Over time the cut healed shut. Recently I have been experiencing headache and a dizzy pressure feeling with kind of a rolling wave sensation. For the first time today it affected the nerves behind my eyes for a few moments. I hope it goes away but your story has gotten my attention.
Thank you for sharing your story as it brings awareness.

I'm a 17 years old girl. 5 months ago I was involved in a Motorcycle accident and I hit my head( right temple) and the side of my neck then I got also a incomplete fracture in my lest arm. After 5 months as in today I'm having a headache in my right temple down to the back of my head like a sudden jolt of pain from back of my head to my right temple. I don't know what to do if is this a part of my accident or just a headache.