Emergency Evaluation Required Immediately
You need emergency medical evaluation right now—persistent headache with inability to hold down food or fluids after a concussion represents a critical warning sign that may indicate serious intracranial injury requiring urgent assessment. 1, 2
Why This Is an Emergency
The combination of persistent headache and repeated vomiting (inability to hold down fluids) after concussion meets the criteria for emergency medical services activation according to the American Heart Association. 1 These symptoms specifically indicate potential life-threatening complications including:
- Epidural hematoma (bleeding between skull and brain) 1
- Subdural hematoma (bleeding beneath the dura) 1
- Brain edema (dangerous brain swelling) 1
- Increased intracranial pressure 1
Immediate Actions Required
Call 911 or go to the emergency department immediately. 1, 2 Do not wait to see if symptoms improve, as these warning signs require urgent neuroimaging and medical evaluation. 1
While awaiting emergency care:
- Remain as still as possible to avoid worsening any potential brain injury 1
- Do not take anything by mouth if vomiting continues 1
- Have someone stay with you to monitor for deterioration in mental status 1
Understanding the Severity
The American Heart Association specifically identifies both "worsening headache" and "repeated vomiting" as red flags mandating emergency evaluation after head injury. 1 While nausea is common in concussion (occurring in the majority of cases), the progression to inability to hold down fluids represents repeated vomiting, which crosses the threshold from typical concussion symptoms to emergency warning signs. 1, 3
Vomiting has been identified as a particularly reliable indicator of more serious brain injury requiring immediate assessment. 4 The inability to maintain hydration compounds the urgency, as dehydration can worsen brain injury outcomes. 1
Common Pitfall to Avoid
Do not assume this is "just a normal concussion symptom." While headache is the most common concussion symptom (occurring in the majority of cases), and nausea is also common, the persistence and severity of these symptoms—particularly the inability to hold down fluids—distinguishes this from typical concussion recovery. 1, 3 Loss of consciousness occurs in less than 10% of concussions, so its absence does not indicate your injury is mild. 3, 2
What Emergency Evaluation Will Include
Emergency providers will:
- Perform neurological examination to assess for focal deficits 1
- Obtain CT imaging to rule out intracranial bleeding or skull fracture 1
- Assess for signs of increased intracranial pressure 1
- Provide IV fluids if dehydrated from vomiting 1
- Determine if hospital admission is required for observation 1
After Emergency Evaluation
If imaging rules out serious structural injury, you will still require close follow-up with a healthcare professional trained in concussion management within 24-48 hours. 2 Complete cognitive and physical rest is required until symptoms resolve. 2 Most concussion symptoms resolve within 7-10 days, though 15-20% of patients develop persistent symptoms beyond 3 months. 1, 3