Is It Dangerous If You Hit Your Head and Bleed Without Pain?

Is there a risk if I hit my head and there is bleeding but no pain?

A family member (around 50 years old with no history of cardiovascular disease) accidentally fell this morning and hit their head against a sharp object.
At the time, there was approximately enough blood to soak two tissues, but it stopped bleeding in less than five minutes.
The impact was painful initially, but they were able to stand up within a minute, did not lose consciousness, and did not experience any instability or other symptoms.
Several hours later, they did not feel any pain and even rode a motorcycle out.
Should there be any concern about this? Thank you, doctor, for your response.

Ida, 20~29 year old female. Ask Date: 2022/04/13

Dr. Jiang Junyi reply Neurology

Dear Ms.
Ida,
You mentioned that a family member (around 50 years old, with no history of cardiovascular disease) accidentally fell this morning and hit their head against a sharp object, resulting in approximately the amount of blood that would fill two tissues, but it stopped bleeding in less than five minutes.
After a head injury, patients often experience some degree of drowsiness and dizziness.
It is advisable to wake the patient once an hour and engage in brief conversation for the first 24 hours post-injury.
Generally speaking, if there is no loss of consciousness, no anticoagulant medication has been taken, and there are no obvious local hematomas, most head injuries are mild.

Head trauma caused by a sudden direct or indirect impact can affect brain function.
The severity of brain injury can range from mild, which may heal on its own, to severe, resulting in damage to brain nerves and tissues, leading to secondary ischemic brain lesions.
Delayed intracranial hemorrhage typically occurs within 48 hours, with an incidence of about 5%.
However, the following symptoms should prompt consideration of delayed bleeding and a visit to the emergency room: (1) worsening vision, double vision (diplopia), or unequal pupil size; (2) watery fluid or blood leaking from the ears or nose; (3) confusion or abnormal behavior; (4) numbness or inability to move limbs; (5) involuntary movements or seizures.
If pain relief is needed, it is recommended to take single-ingredient acetaminophen, with a maximum dosage of 4 grams per day, as it is less harsh on the stomach compared to other pain relievers.
It is advisable to follow up with a neurology or neurosurgery outpatient clinic.
However, due to the recent increase in COVID-19 cases, please ensure to practice self-protection, maintain cleanliness and disinfection, and adhere to new preventive measures before and after seeking medical care.
Thank you for your inquiry, and feel free to discuss any related questions further! Wishing you good health and safety.
Dr.
Jiang Junyi, Taoyuan Hospital

Reply Date: 2022/04/13

More Info

When it comes to head injuries, especially those involving bleeding, it is crucial to understand the potential risks and the appropriate steps to take afterward. In the scenario you described, your family member experienced a fall that resulted in bleeding from the head but did not lose consciousness or exhibit any immediate severe symptoms. This situation raises important questions about the potential for serious complications, such as intracranial bleeding, and what actions should be taken.

First, it is essential to recognize that bleeding from the scalp can occur without any serious underlying injury. The scalp is highly vascularized, meaning it has a rich supply of blood vessels. Therefore, even minor injuries can lead to significant bleeding. However, the presence of bleeding does not automatically indicate a severe head injury or intracranial bleeding. The key factors to consider are the mechanism of injury, the symptoms following the injury, and any changes in the patient's condition over time.

In your case, the fact that your family member experienced pain initially but was able to stand up, did not lose consciousness, and did not exhibit any signs of confusion or instability is reassuring. These factors suggest that the injury may not be severe. However, it is important to monitor for any delayed symptoms, as some complications can manifest hours or even days after the initial injury.

Intracranial bleeding, such as a subdural hematoma or epidural hematoma, can occur after a head injury, particularly if there was a significant impact or if the individual is on anticoagulant medications. Symptoms of intracranial bleeding can include persistent headache, confusion, dizziness, nausea, vomiting, seizures, or changes in consciousness. If any of these symptoms develop, it is critical to seek medical attention immediately.

In general, after a head injury, it is advisable to observe the individual closely for at least 24 hours. This includes waking them periodically to ensure they are responsive and checking for any changes in their condition. If they exhibit any concerning symptoms, such as those mentioned above, they should be taken to the emergency room for further evaluation.

In summary, while the initial lack of pain and the cessation of bleeding are positive signs, it is essential to remain vigilant for any delayed symptoms. If your family member continues to feel well and does not develop any new symptoms, it may not be necessary to seek immediate medical attention. However, if there are any changes in their condition or if you have any concerns, it is always better to err on the side of caution and consult a healthcare professional. Monitoring and being aware of the signs of potential complications are key to ensuring safety after a head injury.

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