Someone has banged their head — when should I worry?
The NHS red flags that mean 999, the ones that mean NHS 111 or urgent care, and what looking after a minor head injury at home actually involves for the following twenty-four hours.
- Difficulty
- beginner
- Time
- 8 min
- Read
- 5 min
- Safety
- warning
Short answer
Call 999 for: knocked out and not woken, cannot stay awake, a fit, a fall of more than a metre or five stairs, vision or hearing problems, clear fluid from the ears or nose, new numbness or weakness, or a high-speed impact. Contact NHS 111 for vomiting, dizziness, being on blood thinners, or anything else worrying you. Otherwise: ice wrapped in a cloth, rest, paracetamol, and an adult staying with them for at least 24 hours.
Most bumps to the head are exactly what they look like. The reason head injuries get treated seriously is that the small number that are not can look identical in the first hour, and the symptoms that separate them are specific and worth knowing rather than guessing at.
Safety
Step by step
- Check for the 999 signs first.Knocked out and not woken up. Cannot stay awake or keep their eyes open. A fit or seizure. A fall from more than a metre or more than five stairs. Problems with vision or hearing. Clear fluid from the ears or nose. New numbness or weakness anywhere. A high-speed impact such as a road accident. Any one of those is an ambulance.
- Then check the NHS 111 signs.Vomiting, dizziness, being on a blood thinner or having a condition that thins the blood, or any other symptom that worries you. NHS 111 will assess and direct you, and it can book you straight into the right service.
- Take blood thinners seriously.Anyone on anticoagulant medication who bangs their head is in a different category, because bleeding inside the skull is both more likely and slower to show. Get advice even if they seem completely well.
- Understand what concussion is.A temporary disturbance of brain function from an impact. Headache, feeling dazed or confused, memory gaps around the event, nausea, or difficulty concentrating. It does not require being knocked out, and it is not something to push through.
- Look after a minor head injury properly.An ice pack or a bag of frozen peas wrapped in a tea towel for swelling, rest, and paracetamol for pain. NHS advice is that an adult should stay with the person for at least the first 24 hours.
- Know what to avoid afterwards.NHS advice is not to return to work or school until better, not to drive until fully recovered, not to play contact sports for at least three weeks, not to drink alcohol or take drugs, and not to take sleeping pills without medical advice.
- Watch through the following day and night.Deterioration is the thing to catch. Increasing drowsiness, worsening headache, repeated vomiting, confusion, or unusual behaviour after an initially reassuring period all mean getting help.
- Be more cautious with the very young and the elderly.Babies and small children cannot describe symptoms, and older people fall more, bleed more readily and are more often on blood thinners. Lower the threshold for asking in both groups.
Tips
- Write down the time of the injury, what happened, and whether they lost consciousness at all. Those three facts are the ones every clinician will ask for.
- The old advice about waking someone hourly through the night has been superseded — current NHS advice is that an adult stays with them and watches for deterioration. If they are difficult to rouse, that is a symptom, not a reassurance exercise.
- In sport, the settled principle is if in doubt, sit them out. A second impact before the first has recovered is the serious scenario.
Common mistakes
- Judging severity by how big the bump is — A large scalp swelling is often nothing and a serious bleed inside the skull may show nothing outside at all. The symptoms matter; the lump does not.
- Assuming that being conscious means it is fine — Most people with a significant bleed are conscious at first. The pattern to watch is deterioration over the following hours, which is why someone stays with them.
- Giving ibuprofen or aspirin for the pain — NHS advice for a head injury is paracetamol. Ask NHS 111 or a pharmacist before using anything else, particularly anything that affects clotting.
- Going back to sport or the gym the next day because the headache has gone — Recovery from concussion takes longer than symptoms suggest, and NHS advice is to avoid contact sport for at least three weeks.
If it doesn't work
A child has banged their head and is crying but otherwise normal
Cause: The usual course of a minor knock — Fix: Comfort them, apply a wrapped cold pack, and watch. Crying immediately and then settling is reassuring; unusual sleepiness, repeated vomiting or not being themselves is not.
They vomited once, then seemed fine
Cause: Vomiting is on the NHS list for contacting 111 after a head injury — Fix: Ring NHS 111 and describe it. One episode in a child is common and it is still worth the call, because it changes the assessment.
Headache and difficulty concentrating several days later
Cause: Post-concussion symptoms, which can persist — Fix: Contact a GP. Persisting symptoms after a head injury are worth assessing rather than waiting out, particularly if they are affecting work, study or driving.
Questions people ask
Should I keep someone awake after a head injury?
No — sleep is not dangerous in itself and NHS advice is that an adult stays with them for at least 24 hours. What matters is whether they can be roused normally. Someone who cannot be woken properly needs 999.
Can I drive myself to A&E?
Not after a head injury. NHS advice is not to drive until fully recovered, and where any of the 999 signs are present you should be calling an ambulance rather than driving at all.
How long does concussion last?
Most people recover within a couple of weeks, and some take longer. Symptoms that persist, or that get worse rather than better, are a reason to go back to a GP.
What if they were wearing a helmet?
A helmet greatly reduces injury and does not eliminate it. The same red flags apply, and a helmet that has taken a significant impact should be replaced rather than reused.