Symptoms to Monitor After a Head Injury
After a head injury, patients should be monitored for worsening headache, repeated vomiting, increased drowsiness, confusion, memory problems, focal neurologic deficits, seizures, abnormal behavior, and visual disturbances, as these symptoms may indicate serious intracranial pathology requiring immediate medical attention. 1, 2
Immediate Warning Signs (Return to Emergency Department)
Monitor for these critical symptoms that require immediate medical evaluation:
- Worsening headache - especially if severe or progressively increasing
- Repeated vomiting - particularly concerning if persistent
- Increased drowsiness or difficulty waking up - indicates deteriorating neurological status
- Confusion or disorientation - new or worsening
- Memory problems - inability to recognize people or places
- Focal neurologic deficits - weakness, numbness, or coordination problems
- Seizures - any seizure activity after head injury
- Abnormal behavior - personality changes or inappropriate behavior
- Visual disturbances - blurred vision, double vision, or other visual changes 1, 2
Postconcussive Symptoms to Monitor
These symptoms may persist for weeks to months and should be tracked:
Physical Symptoms
- Chronic headaches
- Dizziness and balance problems
- Nausea
- Fatigue or feeling tired all the time
- Vision problems
- Sensitivity to light and noise
- Sleep disturbances (sleeping more than usual or trouble falling asleep)
- Numbness or tingling 1
Cognitive Symptoms
- Difficulty concentrating
- Memory problems
- Feeling slowed down
- Feeling "in a fog"
- Trouble with attention 1
Emotional/Behavioral Symptoms
- Depression or mood swings
- Anxiety
- Irritability
- Emotional lability
- Sadness
- Nervousness 1
Monitoring Protocol
First 24-48 hours: Close observation for any of the immediate warning signs listed above
Documentation: Use a postconcussion symptom scale to track symptoms (rate from 0-6 for severity) 1
Follow-up evaluation: Schedule within 24-72 hours after injury to reassess symptoms 2
Duration of monitoring: Continue monitoring for at least 3-4 weeks, as postconcussive symptoms may persist 1
Special Considerations
No need for frequent waking: Home observation with frequent waking of the patient is not supported by evidence and is not recommended 1
Written instructions: Provide discharge instructions in written form at approximately sixth to seventh-grade reading level (minimum 12-point font) as patients often forget verbal instructions 1
Risk factors for prolonged symptoms: Presence of headache, nausea, and dizziness in the emergency department correlates with higher risk of developing persistent postconcussive syndrome 1
Return to activity: Patients should refrain from strenuous mental or physical activity until symptom-free, which may require 2-3 days off work or school 1
When to Seek Specialist Care
Refer to a specialist in traumatic brain injury if:
- Symptoms persist beyond 2-3 weeks
- Symptoms are severe or worsening
- Patient has multiple concussions
- Patient has complex medical history 1, 2
Remember that postconcussive symptoms can affect a patient's personal, financial, and social life, so proper monitoring and early intervention are essential for optimal recovery 1.