How should I manage a patient with a mild head injury who is experiencing persistent headaches and dizziness?

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 ². If symptoms are worsening, referral to the emergency department is recommended as this may suggest a complication ¹.
• 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 ¹.
  • Advise the person to gradually return to normal activities, encouraging a regular schedule of activity and sleep ¹.
  • Consider and investigate other potential causes of the symptoms as appropriate ¹.
  • Address any comorbidities or secondary problems that may complicate recovery, such as stress, depression, or chronic pain ¹.
• Assessment for Associated Issues:
  • Assess for symptoms of anxiety, low mood, flashbacks, and nightmares, particularly if symptoms persist for more than 3 months ¹. Referral for cognitive behavioural therapy (CBT) may be appropriate ¹.
  • Assess for any issues with alcohol and drug misuse, and offer support as needed ¹.
• 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 ².
  • Referral to neuroendocrinology may be considered to exclude complications like hypopituitarism, which can present with non-specific symptoms ¹.
  • If there are persistent or new-onset focal neurological signs, specialist referral to neurology should be arranged ¹.
• 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) ¹,².
  • Inform them about the possibility of persistent or delayed symptoms and who to contact for ongoing problems ².
  • 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 ¹,².