Head Injury After Hospital Discharge: Warning Signs and Recovery at Home

Many people are discharged within hours or days of a head injury, once scans and observation show nothing urgent. That is reassuring, but the brain can still swell or bleed slowly in some cases, and this may show itself only after the person is home. For this reason hospitals give a written discharge sheet and ask that a responsible adult stays with the patient. Follow the sheet from your own hospital first; this guide adds general background and does not replace it.

For the first 24 to 48 hours, someone should be nearby, able to notice changes and take the person to emergency care quickly. Waking the person occasionally at night to check they respond normally is sometimes advised, but follow the instruction given by the treating team rather than a general rule.

Take the person to the nearest emergency department, or call an ambulance, if any of these appear after a head injury:

• a headache that keeps getting worse, or a sudden severe headache,
• repeated vomiting,
• growing sleepiness, difficulty waking, or confusion that is increasing,
• a seizure or fit,
• new weakness, numbness, clumsiness or loss of balance on one side,
• slurred or confused speech, or trouble finding words,
• changes in vision, double vision, or one pupil clearly larger than the other,
• clear fluid or blood coming from the nose or ear,
• unusual behaviour, agitation or a change in personality,
• bruising behind the ear or around the eyes after a significant blow.

Do not wait to see whether it passes, and do not give sedating medicines or alcohol. Children, older adults and anyone taking blood thinners need a lower threshold for seeking care, because bleeding inside the head is more likely to be serious in these groups.

Even after a mild injury, many people feel unwell for days to weeks. This is often called post-concussion symptoms. It does not mean permanent damage, and most people improve steadily.

• Headache, often tension-type or related to the neck.
• Dizziness or imbalance, especially with quick head movement.
• Tiredness that is out of proportion to activity.
• Poor concentration and slower thinking, trouble following conversations or screens.
• Sensitivity to light and noise.
• Sleep disturbance, either too much or too little.
• Irritability, low mood or anxiety.
• Nausea, particularly early on.

Most adults recover from a mild injury within a few weeks, though some take longer. If symptoms are not improving after about four weeks, or if they get worse, return to the doctor. A small group develops persistent symptoms, and specialist assessment and rehabilitation can help.

Older advice was to lie in a dark room for weeks. Current guidance from concussion consensus statements is different: brief relative rest in the first day or two, then a stepwise return to normal activity as symptoms allow. Complete inactivity for long periods can prolong symptoms, while pushing hard into symptoms can set recovery back.

A practical approach is the "traffic light" idea. Light symptom increases that settle within an hour or so are acceptable. If an activity brings on marked headache, dizziness or fatigue that lasts, step back to the previous level and try again the next day.

• Start with short walks at a comfortable pace.
• Add light household tasks and short periods of reading or screens with breaks.
• Increase time and effort a little every day or two, never several things at once.
• Avoid activities with a risk of another blow to the head until the doctor says it is safe.

Brain injury fatigue is real and different from ordinary tiredness. Thinking, planning and filtering noise all cost energy, so a shopping trip can feel like a day of heavy work. Families sometimes mistake it for laziness. Encourage short activity blocks of 20 to 30 minutes with planned rests, do the demanding task at the best time of day, and stagger visitors. Keep a simple diary of activity, sleep and symptoms; patterns appear within a week and help the doctor and therapist.

Memory and attention difficulties are described in our guide on memory, attention and thinking problems. Although it is written about stroke, many of the home strategies, such as notes, single-tasking and quiet environments, apply after head injury as well.

Sleep often changes after a head injury. Keep regular bed and wake times, avoid caffeine late in the day, limit screens in the hour before bed, and avoid long daytime naps. Our guide on sleep problems and night routines includes practical positioning and routine tips. Mood changes are also frequent. Anxiety, low mood and irritability affect many people in the first months, and they are treatable. If sadness persists, or the person speaks about harming themselves, seek medical help straight away. See depression and mood changes for signs families can watch for.

Dizziness after a head injury has several possible causes: inner-ear problems such as positional vertigo, disturbed eye and head coordination, neck injury, or simply fatigue. A physiotherapist trained in vestibular and balance rehabilitation can assess which applies and can teach safe exercises, such as gaze stability practice and graded balance work. Do not try aggressive head-turning manoeuvres from the internet without assessment, since the wrong approach may worsen symptoms.

Neck pain and headaches that come from the neck are common after a blow or whiplash-type movement. Gentle mobility, posture advice and gradual strengthening often help, once serious injury has been excluded by the doctor.

Some people have a seizure soon after a significant head injury, and a small number develop epilepsy later, especially after moderate or severe injuries. A seizure is always a reason to seek medical care. Read seizures after stroke or brain injury to learn first aid: protect the head, turn the person on their side after the shaking stops, do not put anything in the mouth, and call for help if it lasts more than five minutes or repeats.

When the injury was more serious, discharge may follow a longer stay and rehabilitation. Weakness, spasticity, balance loss, swallowing or speech problems, and changes in thinking and behaviour may be present. Home rehabilitation then focuses on safe positioning, transfers, walking practice, fall prevention and supporting the family. Our fall prevention guide and caregiver guide are useful starting points. A structured programme like the one in designing a home programme can be adapted after a brain injury.

Behaviour change, impulsivity and poor judgement can be the hardest part for families. Keep routines predictable, give one instruction at a time, avoid arguing in the moment and tell the team about safety concerns.

Return in steps, not all at once. A phased return to school or work with shorter days and lighter tasks is often best. Do not drive until the doctor has said it is safe and the person is free of dizziness, double vision and slowed reaction, and seizures have been addressed. Contact sport and activities with a risk of falling or head contact should wait until symptoms have fully settled and the doctor or a sports medicine professional agrees. Children and teenagers need particular care, since a second injury before recovery can be serious.

Home physiotherapy does not replace medical follow-up or emergency care. It can support recovery by assessing balance, neck and movement; planning a graded return to walking and daily activity; teaching pacing and energy conservation; working on mobility and strength after more serious injuries; and training the family in safe handling and fall prevention. Seeing the home allows advice about bathrooms, stairs and lighting to be specific. Read about our home neurological rehabilitation or book a home visit.

This guide is general education only. Always follow the discharge instructions given by your own hospital.