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Head injury - Management
How do I manage a person with persistent symptoms following a head injury?

  • If the person returns complaining of ongoing symptoms after a minor head injury, take a detailed history and perform a thorough examination.
    • If the person has 'red flag' symptoms or signs (such as altered consciousness), refer to an emergency department.
    • If the person does not have 'red flag' symptoms and signs (for example, they present with: persistent [but not worsening] headache; dizziness; generalized weakness; tinnitus; nausea; problems with mental activity [such as comprehension and memory]; sleep deprivation and fatigue):
      • Reassure that symptoms do not usually have a serious underlying cause, and normally resolve within 3 months of the injury.
      • Advise early return to activity, but also advise reducing daily demands and gradually returning to usual activities (if possible).
      • Advise a regular schedule of activity and sleep if fatigue and sleep deprivation are issues.
      • Provide appropriate treatment for specific symptoms (such as analgesia or depression).
    • Refer for appropriate specialist assessment (such as neurology, neuropsychology or psychiatry) if:
      • The person is distressed by their symptoms despite treatment and a period of watchful waiting for 3 months.
      • There are clinical concerns regarding type or severity of individual symptoms.
  • Consider if the person's on-going symptoms could be due to hypopituitarism, particularly if the brain injury was severe. Refer to a neurologist or endocrinologist for further assessment if appropriate.
    • Symptoms of hypopituitarism include tiredness, thirst, polydipsia, polyuria, amenorrhoea, erectile dysfunction, loss of libido, impaired cognitive function, and/or depression.
    • The symptoms of hypopituitarism following traumatic brain injury are often non-specific and similar to symptoms commonly experienced by people following a head injury. As a result, hypopituitarism following traumatic brain injury often remains unrecognized.

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