Initial Treatments for Head Trauma

Early Treatment for Head Trauma Saves Function

Treatment of head trauma depends on the severity of the trauma, and which structures of the head have been damaged.

Head trauma can injure the:

  • Brain
  • Eyes
  • Ears
  • Sinuses
  • Facial bones
  • Skull bones
  • Facial and Cranial nerves
  • Skin and soft tissues

Complete Health Assessment

Before treatment begins, a complete physical and neurological exam needs to be performed.

In mild head injuries the primary doctor may complete this exam and suggest referrals to various specialties, such as an ophthalmologist to examine the eyes.

The Emergency Department is also an appropriate place to be evaluated for head trauma, even if it appears to be a mild injury. If stitches or antibiotics are needed, the ER can provide all of these services in one place.

Moderate to severe head trauma should always be considered dangerous, and the injury victim must be evaluated by emergency services.

Treatment for Moderate to Severe Head Trauma

The first treatment the medical team provides is to make sure the head trauma injury victim has an open airway, can breathe, and is maintaining normal blood pressure and heart rate.

It is very likely that x-rays, a Computed Tomography (CT) scan, and/or a Magnetic Resonance Image (MRI) will be completed. These tests identify fractures, bleeding and other damage to the head and all of its structures. Once the extent of the damage is known, treatment can begin.

If bleeding is seen in or around the brain, surgery may be required.

A neurosurgeon will remove excess blood and attempt to stop the bleeding. Part of the bony skull may be left off so the brain is able to swell and maintain a safe level of pressure. This part of the skull will be replaced later.

Surgery is also necessary to stabilize broken facial and skull bones, eye injuries, and other injuries that are present.

When the patient comes out of surgery s/he will likely go to the Intensive Care Unit with a small probe in the brain that measures Intra-Cranial Pressure (ICP). Treatment at this point prioritizes keeping pressure inside the skull within a safe range. A variety of medications are used to accomplish this.

An individual with head trauma and traumatic brain injury often needs to be sedated. This is to keep their stress level, heart rate and blood pressure low. Because of the high levels of sedating medicines, and need to keep the patient quiet, it is common for patients to be mechanically ventilated.

A small shunt may be placed through the skull and into the brain to drain excess fluid and blood. IV fluids and a feeding tube are used to maintain hydration and deliver nutrients. A catheter that drains the bladder is also in place.

By keeping the patient quiet and managing breathing, heart rate and nutritional needs very carefully, care providers manage the metabolic needs of the patient. This provides time for the brain to begin healing.

Once the patient is stabilized, rehabilitation can begin even if the patient is still sedated. Range of motion exercises prevent the muscles from breaking down, and maintain flexibility. Rehabilitation will be fundamental element of treatment over the long term.

Treatment for Mild Head Trauma

We now know that mild head trauma is associated with long term effects that can benefit from early treatment. According to the research, minute changes in how the eyes are able to focus (called accommodation) makes concentrating difficult and leads to fatigue.

There are emotional consequences of head trauma such as Post Traumatic Stress Disorder (PTSD) from the accident. Emotional changes such as depression, personality changes and impatience are also present in a segment of the head trauma population.

A complete eye examination by a specialist ophthalmologist can detect accommodation problems. Counseling, occupational therapy and, if indicated, antidepressants may be helpful.


Bush, S. S., & Carone, D. A. (2013). Mild Traumatic Brain Injury : Symptom Validity Assessment and Malingering. New York: Springer Publishing Company.

Gervasio, K. A., Weinstock, B. M., & Wu, A. Y. (2015). Original Articles: Prognostic Value of Ocular Trauma Scores in Patients with Combined Open Globe Injuries and Facial Fractures. American Journal Of Ophthalmology, doi:10.1016/j.ajo.2015.08.007

Reis, C., Yuechun, W., Onat, A., Wing Mann, H., Applegate II, R., Stier, G., & ... Zhang, J. H. (2015). What's New in Traumatic Brain Injury: Update on Tracking, Monitoring and Treatment. International Journal Of Molecular Sciences, 16(6), 11903-11965. doi:10.3390/ijms160611903

Thiagarajan, P., & Ciuffreda, K. J. (2014). Effect of oculomotor rehabilitation on accommodative responsivity in mild traumatic brain injury. Journal Of Rehabilitation Research & Development, 51(2), 175-191. doi:10.1682/JRRD.2013.01.0027

Wheeler, L., & Puskar, K. (2015). Veterans with co-morbid posttraumatic stress disorder and mild traumatic brain injury: the nurse practitioners role in facilitating treatment. Journal Of Military & Veterans' Health, 23(1), 42-46.

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