Whether it’s knocking your head on a table after picking something up or hitting your head from a slip and fall, we’ve all accidentally bumped our heads. But how do you know if you should be worried about a head injury? And if an older person hits their head, should you take that more seriously?

There are several factors to consider, says Dr. Louise Klebanoff, a neurologist at NewYork-Presbyterian/Weill Cornell Medical Center. “As doctors, we want to know the nature of the injury. Things like the force and speed of a hit or the distance traveled in a fall would all factor into assessing the severity of a head injury,” she says. “We can help sort out what to be concerned about.”

Dr. Klebanoff shares tips with Health Matters on what to know about minor head injuries, concussion signs to watch out for, and which treatments are most effective after someone bumps their head.

How do you define a head injury?

A closed head injury — or a head strike — can be anything from completely benign to something life-threatening that causes bleeding into the brain. An open head injury is the result of a severe trauma that penetrates or fractures the skull and exposes the brain to the surrounding air.

A more severe closed head trauma can lead to a concussion, which is often associated, though not exclusively, with a loss of consciousness; it can also include persistent headache, dizziness, confusion, or fatigue after the injury.

What are some things to consider after a head injury?

If someone has fallen, consider the height from which the fall occurred. The longer the distance you fall, the higher the risk of injury. You would be less concerned about a 6-inch fall, for example, than a 6-foot fall.

Also take into consideration the surface onto which someone has landed. Falling on the carpet is a little less concerning than falling on concrete. If the injury occurred from a head strike, the harder the object and the faster it hit could result in a more severe injury.

Does a person’s age factor into the potential severity of the injury?

In older people, we’re really concerned about the reasons for the fall, particularly if it could be related to other potential medical issues. There’s a difference between accidentally tripping on an object and having some sort of cardiac event that causes them to fall. We’re also concerned about their medical history, especially if they are on blood thinners. If that’s the case, the person should probably be assessed in an emergency room.

For both older and younger people, what are the signs of a serious head injury that needs medical attention?

Consider urgent medical attention if there was a significant loss of consciousness for more than a few minutes or if there was a seizure on impact. A change in pupillary reaction or eye movements can be seen in patients with significant head injury, but unless you are trained in assessing the eyes, I would not recommend testing this on your own. Other signs could include appearing confused or lethargic, or having nausea, dizziness or vomiting after a fall. And if a person has any localizing symptoms — if they’re weak on one side, numb on one side, if they’re not able to walk, or if they’re having difficulty speaking or understanding speech — they will want to get assessed in an emergency room, where it is likely a person will get scanned. Usually, a CT scan is going to show us acute blood, which is what we’re concerned about after a fall.

You also want to watch for any symptoms that get progressively worse over time, like a headache that worsens when you lay down, or one that disrupts your sleep or feels worse in the morning. Those are signs of increased intracranial pressure and that’s concerning.

Sometimes older patients don’t present with a headache, but with lethargy because they’re experiencing a subdural hematoma, which accumulates slowly over time and increases pressure in the head. That person might be a little slow, a little confused, or have a little trouble walking. They should go to an emergency room right away for a scan. And I would be more prone to get a follow up scan, too, because sometimes a subdural hematoma will leak over time.

Should you alter your daily schedule or refrain from certain activities after a head injury?

In addition to keeping an eye out for worsening symptoms, it’s best to listen to your body. For example, if you find that working on screens increases your headache or causes dizziness or fatigue, limit your screen time and introduce it back slowly into your routine. We also caution people against drinking alcohol until they’re 100 percent better because alcohol is bad for the recovering brain.

If you’re dealing with a concussion, the treatment is mostly time and observation. Most people after a concussion will improve by 30 days. But if someone has persistent symptoms, like headaches or dizziness, they should go back to their doctor.

Is it true you should avoid going to sleep after a head injury?

After a substantial head injury, it’s probably not a great idea to go to sleep alone; it’s better to be around somebody who can offer support and observe any symptoms. But I don’t think the person needs to be woken up and checked on every half hour.

Sometimes a head bump can seem like a small injury but wind up having life-threatening consequences. What can someone do to try and avoid complications?

If a friend or family member has had a significant head bump and they’re not acting quite right, it’s best to get them evaluated. The best place for urgent evaluation of the head injury is the Emergency Room.  The severity of the injury can be assessed, as well as the underlying reason for the trauma. 

If a headache doesn’t go away, I’m going to want to examine the patient. If there are persistent or worsening symptoms, then the patient should be evaluated, preferably in person, by a neurologist. If there’s any concern about a neck injury, I might get an X-ray of the cervical spine.

How might people be more mindful to prevent head injuries?

If you’re doing something active, wear a properly fitted helmet. If your walking isn’t stable, especially if you’re older, then try not to be distracted while you walk, and use a cane or walker if that has been recommended. And be careful when you’re walking on New York City sidewalks, as they can be very irregular.