I Hit My Head. Should I Worry?

You’ve just fallen and bumped your head. Or maybe you smacked your noggin on an open kitchen cupboard. You’re not sure whether it’s a big deal. Should you rush to the emergency room or just take it easy for a few days?

Any time you hit your head as an older adult, it should be taken seriously. As we age, our brains shrink. When there’s more wiggle room inside the head, there’s more stretch on the vessels that connect the brain to the skull. A traumatic brain injury (TBI) may occur with a blow or jolt to the head that can cause the soft brain inside the hard, bony skull to slosh around. That movement can lead to bleeding, bruising or brain swelling that may require medical attention, even if you don’t believe your injury is severe.

Even a concussion, which is a mild TBI, can cause bleeding inside the brain, bruising and more, which can lead to headaches, confusion and short-term memory loss.

Here are questions to ask yourself if you hit your head:

• Did I lose consciousness?
• Am I seeing stars? Is there any change in my vision?
• Am I nauseous? Did I vomit?
• Am I dizzy?
• Are my arms or legs weak?
• Am I feeling sluggish or low-energy?

If you answer yes to any of the above, it should be treated as a medical emergency, says Dr. David Okonkwo, professor of neurological surgery at the University of Pittsburgh and executive vice president of UPMC Enterprises.

Even if you don’t answer yes to any of those questions, it’s still important to monitor yourself for symptoms that may appear in the following days, Okonkwo says. He’s referring to worsening fatigue or sleepiness, headache, new weakness on one side of the body or vomiting.

“These brain bleeds can be somewhat slow and subtle, and they might be fine until they’re no longer fine,” says Jeffrey Rollman, assistant professor in the department of emergency health sciences at the University of Texas at San Antonio.

Nearly 3 million people seek medical attention for TBI each year in the United States. In an 18-year study, almost 13 percent of older adults experienced a TBI. That research was by scientists at the University of California San Francisco and the San Francisco VA Health Care System.

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Special attention when on blood thinners

Anyone on blood thinners should be extra vigilant about getting medical attention after a fall or any bump to the head, Okonkwo says. Blood thinners increase a person’s risk of bleeding, so there may be bleeding inside the skull that you don’t realize is happening. That plus the extra space around the brain means it may take a while for any bleeding to cause symptoms.

This doesn’t mean you should call 911 right away, but it’s important to monitor your symptoms closely in the coming days and reach out to your doctor if symptoms suddenly occur, Okonkwo says.

If your symptoms do progress, your doctor may recommend a CT scan to see if there’s bleeding. “Whenever there’s blood in the head, we are more concerned,” says Dr. Louise Klebanoff, chief of general neurology at Weill Cornell Medical College in New York City. “There could be more complications, and patients really need to be monitored.”