Head Pain After a Fall: A Guide for Caregivers

Grandma has a headache after falling?

Hello, my grandmother is 90 years old and has limited mobility, relying on a walker to move around.
Two days ago, she got up around 5 AM to use the bedside commode and lost her balance after finishing, resulting in a fall where she hit the top and back of her head near the left ear.
Since then, she has been unable to sleep well at night, frequently getting up and complaining of headaches—sometimes at the top of her head, sometimes at the temples (migraine-like), and pain at the site of the impact on the back of her head.
Last night, seeing her in pain and unable to sleep, I gave her a previously prescribed medication for neuropathic pain, "Gatine (Gabapentin) 300mg/yellow capsule." After taking it, she slept soundly until morning, when she got up to use the restroom (previously, she would wake up three times at night).
She then slept until after 10 AM, and I had to wake her up at 11:30 AM for breakfast (normally, she wakes up around 9 AM).
Today, aside from meal times, she has been mostly sleeping (even dozing off while sitting).
I'm not sure if this is due to the lack of sleep over the past two days (including not napping) or the effects of the medication, or if it’s related to the head injury.
Today, her walking to the restroom was noticeably slower compared to yesterday (I’m unsure if this is a side effect of Gatine, as the medication information states that a few individuals may experience drowsiness, ataxia, or fatigue).
This evening, she mentioned pain in her left ear and external pain at the site of the head impact, so I gave her another dose of Gatine.
I just looked up symptoms related to head trauma, and most do not apply; there is no fluid discharge from her ears or nose.
She regularly visits the cardiology clinic for medications related to diabetes, blood pressure, and heart conditions.
Recently, the doctor prescribed an additional medication to help increase her walking distance.
I am still concerned about the possibility of complications from her fall.
Given her current condition, do you think it is necessary to seek immediate medical attention? Thank you for taking the time to read this lengthy message.

Jeffrey, 20~29 year old female. Ask Date: 2012/11/09

Dr. Lan Shengxing reply Neurology

Hello Jeffery, the headache symptoms you described may simply be pain caused by the fall.
Using acetaminophen should be sufficient.
When administering pain relief after a fall, it is advisable to avoid medications that may cause drowsiness, in order to prevent confusion in diagnosing any potential consciousness impairment resulting from the fall.

Reply Date: 2012/11/09

More Info

Understanding head pain after a fall, especially in elderly individuals, is crucial for caregivers. Your grandmother's situation, given her age and the circumstances of her fall, requires careful monitoring and potentially immediate medical attention.

When an elderly person falls and sustains a head injury, there are several factors to consider. First, the risk of serious injury, such as a concussion or intracranial hemorrhage, increases with age due to the fragility of the brain and the presence of other health conditions. Symptoms such as persistent headache, confusion, dizziness, or changes in consciousness can indicate a more serious issue that requires urgent medical evaluation.

In your grandmother's case, her complaints of headaches in various locations (top of the head, temples, and the area where she hit her head) are concerning. The fact that she has difficulty sleeping and has been unusually drowsy after taking Gabapentin (Gatine) raises further questions. Gabapentin is often prescribed for nerve pain, but it can cause side effects such as drowsiness, dizziness, and fatigue, especially in older adults. It’s essential to determine whether her increased sleepiness is due to the medication, the pain, or a combination of both.

Here are some steps you can take as a caregiver:
1. Monitor Symptoms: Keep a close eye on her symptoms. If her headaches worsen, if she experiences confusion, difficulty waking up, or if she develops new symptoms such as vomiting, seizures, or weakness, seek medical attention immediately.

2. Medication Review: Consult with her healthcare provider regarding the use of Gabapentin. If she is experiencing significant side effects, her doctor may need to adjust her dosage or consider alternative treatments for her pain.

3. Pain Management: While it’s important to manage her pain, be cautious with over-the-counter pain medications, especially if she is on other medications for chronic conditions. Always consult her doctor before introducing new medications.

4. Hydration and Nutrition: Ensure she stays hydrated and eats well, as dehydration and poor nutrition can exacerbate headaches and overall health.

5. Follow-Up Care: Schedule a follow-up appointment with her primary care physician or a neurologist to discuss her symptoms and the fall. They may recommend imaging studies (like a CT scan) to rule out any serious injuries.

6. Safety Measures: To prevent future falls, assess her living environment. Ensure that it is safe and free of tripping hazards. Consider using assistive devices, such as a walker, and ensure she has help when moving around.

7. Educate Yourself: Understanding the signs of serious head injuries can empower you to act quickly if her condition worsens. Familiarize yourself with the symptoms of concussions and other head injuries.

In summary, while some headaches after a fall can be benign, the combination of her age, the nature of her fall, and her current symptoms necessitates a cautious approach. If you have any doubts about her condition, it is always better to err on the side of caution and consult a healthcare professional. Your grandmother's health and safety are paramount, and timely medical intervention can make a significant difference in her recovery and quality of life.

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