Head injury is one of the most common reasons why people in England have to visit hospital. About one million people will be treated for head trauma in the next year and almost 12,000 of those injuries will be severe. Every year over 17, 000 people who suffer from head injuries will be unable to return to work within five years. Severe head injuries usually mean that the brain has been damaged to some extent. Despite the protective bone covering of the skull, the brain is vulnerable to tears, ruptured nerves and blood vessel damage. Any of these injuries can cause bleeding, swelling or fluid build-up in the head, putting extensive pressure on the brain and resulting in tissue damage.

Mild and moderate head injuries can also cause damage to the brain. A strong blow to the head can leave the skull intact but make the brain jolt, causing tissue damage as it impacts against the skull. Brain damage caused by a head injury is usually referred to as Traumatic Brain Injury (TBI).

TBI can involve three separate events:

This is the initial injury and can be closed (when there is no damage externally), open (when the skull has been damaged enough to expose the brain), or crushing (when the head has been caught between two objects).

This happens when other events or injuries worsen the head injury by restricting blood flow and oxygen supply. This could happen if an object is laying across the throat and obstructing the airway for example.

This can occur days or even weeks after the first injury and is usually a result of swelling, bleeding or bruising in the brain. Third injury causes extreme pressure inside the head and can be fatal in severe cases.

Causes

Road traffic accidents account for up to half of all reported head injuries in the UK. This includes multiple vehicle accidents, vehicle/pedestrian accidents and accidents involving cyclists. Cycling accidents account for about 20% of all head injuries involving children.Other causes of head injuries include domestic incidents, sports-related injuries, industrial accidents such as falls at work, and assault.

Treatment

Damage to the skull usually heals naturally but may take a few months. If the skull has been fractured, bone fragments may be pushed inwards and will need to be repaired with surgery to stop them pressing on the brain. External cuts to the head may require stitches. Damage to the brain may be initially treated with drugs that help to reduce any swelling. An operation will be necessary if a blood clot or internal bleeding is detected.

The treatment for physical, cognitive and emotional and behavioural symptoms of brain damage is usually rehabilitation.

Rehabilitation can include physiotherapy to improve movement, stress management programmes, muscle relaxation techniques and behavioural modification programmes. Nursing staff, physiotherapists and psychologists can advise about the best possible treatment and help to work out a programme that best suits the individual patient.