Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
For a patient with a mild head injury experiencing persistent headaches and dizziness, the primary consideration is whether these symptoms warrant an urgent referral.
- Immediate Referral to Emergency Department: A persistent headache since the injury is a risk factor that necessitates referral to a hospital emergency department from community health services NICE NG232. If symptoms are worsening, referral to the emergency department is recommended as this may suggest a complication NICE CKS.
- General Management and Reassurance:
- Offer reassurance and advice, as early education about the diagnosis, symptoms, and expected prognosis can help create realistic expectations, reduce anxiety, and normalise symptoms NICE CKS.
- Advise the person to gradually return to normal activities, encouraging a regular schedule of activity and sleep NICE CKS.
- Consider and investigate other potential causes of the symptoms as appropriate NICE CKS.
- Address any comorbidities or secondary problems that may complicate recovery, such as stress, depression, or chronic pain NICE CKS.
- Assessment for Associated Issues:
- Assess for symptoms of anxiety, low mood, flashbacks, and nightmares, particularly if symptoms persist for more than 3 months NICE CKS. Referral for cognitive behavioural therapy (CBT) may be appropriate NICE CKS.
- Assess for any issues with alcohol and drug misuse, and offer support as needed NICE CKS.
- Specialist Assessment:
- Consider referring people with persisting problems to a clinician trained in assessing and managing the consequences of traumatic brain injury, such as a neurologist, neuropsychologist, clinical psychologist, neurosurgeon, endocrinologist, or a multidisciplinary neurorehabilitation team NICE NG232.
- Referral to neuroendocrinology may be considered to exclude complications like hypopituitarism, which can present with non-specific symptoms NICE CKS.
- If there are persistent or new-onset focal neurological signs, specialist referral to neurology should be arranged NICE CKS.
- Patient Information and Support:
- Provide verbal and written information to the person and/or their family/carers, including details of the injury, expected recovery process, warning signs for urgent medical review, and information about returning to everyday activities (e.g., school, work, sports, driving) NICE CKS,NICE NG232.
- Inform them about the possibility of persistent or delayed symptoms and who to contact for ongoing problems NICE NG232.
- Offer details of support organisations such as Headway – The Brain Injury Association, The NHS A to Z of health ‘Concussion’, and Brain and Spine Foundation NICE CKS,NICE NG232.