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Traumatic Brain Injury


Traumatic brain injury (TBI) is a sudden injury that causes damage to the brain. It may happen when there is a blow, bump, or jolt to the head. This is a closed head injury. A TBI can also happen when an object penetrates the skull. This is a penetrating injury.

Symptoms of a TBI can be mild, moderate, or severe. Concussions are a type of mild TBI. The effects of a concussion can sometimes be serious, but most people completely recover in time. More severe TBI can lead to serious physical and psychological symptoms, coma, and even death.


How do healthcare providers diagnose traumatic brain injury (TBI)?

Healthcare providers use different tests and measures to diagnose TBI. Often, multiple measures are used together to diagnose TBI and to map out a path for treatment and recovery. Some of these tests are described in the following sections. In addition to “neuro-checks”—a series of quick questions and tasks that help healthcare providers assess how well a TBI patient’s brain and body are working—some in-depth tests help reveal levels of injury or damage in TBI patients.

Healthcare providers who suspect TBI will usually take images of a person’s brain. These image tests can include:

  • Computerized tomography (CT). A CT (or “CAT”) scan takes X-rays from many angles to create a complete picture of the brain. It can quickly show whether the brain is bleeding or bruised or has other damage.

  • Magnetic resonance imaging (MRI). MRI uses magnets and radio waves to produce more detailed images than CT scans. An MRI likely would not be used as part of an initial TBI assessment, because it takes too long to complete. It may be used in follow-up examinations, though.

  • The GCS gives healthcare providers a way to measure a person’s functioning in three key areas:

  • Ability to speak, such as whether the person speaks normally, speaks in a way that doesn’t make sense, or cannot speak at all

  • Ability to open eyes, including whether the person opens his or her eyes only when asked

  • Ability to move, ranging from moving one’s arms easily and on purpose to not moving even in response to pain


A healthcare provider rates a person’s responses in these categories and calculates a total score. A score of 13 or higher indicates a mild TBI, 9 through 12 indicates a moderate TBI, and 8 or below indicates severe TBI.

Doctors can also use the GCS to monitor a patient’s recovery progress.

Other tests for TBI may include:

  • Speech and language tests to determine how well the patient can speak and use language, including how well the muscles needed to form words work and how well the patient can read and write5

  • Social communication skills tests and role-playing scenarios to determine whether a person’s behavior or actions have been affected

  • Tests of swallowing abilities to ensure the patient can swallow safely and receive enough nutrition

  • Tests of breathing abilities and lung function to find out whether breathing assistance or extra oxygen is needed

  • Cognition tests or questions to see how the patient’s thinking, reasoning, problem-solving, understanding, and remembering abilities are

  • Neuropsychological assessments to learn more about the patient’s brain and social functions, including the ability to control one’s behavior and actions

Blood tests to diagnose TBI are an emerging area of research. In 2018, the Food and Drug Administration approved a blood test that detects two proteins, UCH-L1 and GFAP, which are released by the brain into the bloodstream when a mild concussion occurs. The test can help identify individuals whose injury is unlikely to show up on a CT scan, eliminating the need for an unhelpful test. The blood test may also provide a way to quickly diagnose military personnel for a mild concussion.


Researchers at the National Institute of Nursing Research and NICHD found that testing for the blood protein tau could help identify athletes who need more recovery time before they can safely return to play after a sports-related concussion.


Treatment is based on the severity of the injury.


Mild injury

Mild traumatic brain injuries usually require no treatment other than rest and over-the-counter pain relievers to treat a headache. However, a person with a mild traumatic brain injury usually needs to be monitored closely at home for any persistent, worsening or new symptoms. He or she may also have follow-up doctor appointments.


The doctor will indicate when a return to work, school or recreational activities is appropriate. Relative rest — which means limiting physical or thinking (cognitive) activities that make things worse — is usually recommended for the first few days or until your doctor advises that it's OK to resume regular activities. It isn't recommended that you rest completely from mental and physical activity. Most people return to normal routines gradually.


Immediate emergency care

Emergency care for moderate to severe traumatic brain injuries focuses on making sure the person has enough oxygen and an adequate blood supply, maintaining blood pressure, and preventing any further injury to the head or neck.

People with severe injuries may also have other injuries that need to be addressed. Additional treatments in the emergency room or intensive care unit of a hospital will focus on minimizing secondary damage due to inflammation, bleeding or reduced oxygen supply to the brain.



Medications to limit secondary damage to the brain immediately after an injury may include:

  • Anti-seizure drugs. People who've had a moderate to severe traumatic brain injury are at risk of having seizures during the first week after their injury.

An anti-seizure drug may be given during the first week to avoid any additional brain damage that might be caused by a seizure. Continued anti-seizure treatments are used only if seizures occur.

  • Coma-inducing drugs. Doctors sometimes use drugs to put people into temporary comas because a comatose brain needs less oxygen to function. This is especially helpful if blood vessels, compressed by increased pressure in the brain, are unable to supply brain cells with normal amounts of nutrients and oxygen.

  • Diuretics. These drugs reduce the amount of fluid in tissues and increase urine output. Diuretics, given intravenously to people with traumatic brain injury, help reduce pressure inside the brain.



Emergency surgery may be needed to minimize additional damage to brain tissues. Surgery may be used to address the following problems:

  • Removing clotted blood (hematomas). Bleeding outside or within the brain can result in a collection of clotted blood (hematoma) that puts pressure on the brain and damages brain tissue.

  • Repairing skull fractures. Surgery may be needed to repair severe skull fractures or to remove pieces of skull in the brain.

  • Bleeding in the brain. Head injuries that cause bleeding in the brain may need surgery to stop the bleeding.

  • Opening a window in the skull. Surgery may be used to relieve pressure inside the skull by draining accumulated cerebrospinal fluid or creating a window in the skull that provides more room for swollen tissues.



Most people who have had a significant brain injury will require rehabilitation. They may need to relearn basic skills, such as walking or talking. The goal is to improve their abilities to perform daily activities.

Therapy usually begins in the hospital and continues at an inpatient rehabilitation unit, a residential treatment facility or through outpatient services. The type and duration of rehabilitation is different for everyone, depending on the severity of the brain injury and what part of the brain was injured.

Rehabilitation specialists may include:

  • Physiatrist, a doctor trained in physical medicine and rehabilitation, who oversees the entire rehabilitation process, manages medical rehabilitation problems and prescribes medication as needed

  • Occupational therapist, who helps the person learn, relearn or improve skills to perform everyday activities

  • Physical therapist, who helps with mobility and relearning movement patterns, balance and walking

  • Speech and language therapist, who helps the person improve communication skills and use assistive communication devices if necessary

  • Neuropsychologist, who assesses cognitive impairment and performance, helps the person manage behaviors or learn coping strategies, and provides psychotherapy as needed for emotional and psychological well-being

  • Social worker or case manager, who facilitates access to service agencies, assists with care decisions and planning, and facilitates communication among various professionals, care providers and family members

  • Rehabilitation nurse, who provides ongoing rehabilitation care and services and who helps with discharge planning from the hospital or rehabilitation facility

  • Traumatic brain injury nurse specialist, who helps coordinate care and educates the family about the injury and recovery process

  • Recreational therapist, who assists with time management and leisure activities

  • Vocational counselor, who assesses the ability to return to work and appropriate vocational opportunities and who provides resources for addressing common challenges in the workplace


amantadine Off-label

risperidone Off-label

TBI Medication Chart

Anti-convulsant Medications

How They Work:What They Treat:Possible Side Effects:

Anti-convulsant medications are used to suppress the rapid and excessive firing of neurons that start a seizure. Anti-convulsants can sometimes prevent the spread of a seizure within the brain and offer protection against possible excitotoxic (excessive stimulation by chemicals in the nervous system) effects that may result in brain damage. Examples include: sodium valproate, gabapentin, topiramate and carbamazepine.

  • Absence seizures (formally called petite mal seizures)

  • Acute seizures

  • Bipolar disorders

  • Corticofocal seizures

  • Generalized tonic-clonic seizures

  • Panic disorders

  • Sedative/hypnotic (sleep aid)

  • Simple and complex partial seizures

  • Headache

  • Pain

  • Behavioral effects (aggression)

  • Mood stabilizers

  • Alopecia (hair loss)

  • Amnesia (memory loss)

  • Anorexia (eating disorder)

  • Ataxia (muscle incoordination)

  • Confusion

  • Diploplia (double vision)

  • Drowsiness

  • Dysarthria (speech disorder)

  • Insomnia

  • Nausea

  • Nystagmus (rapid, involuntary eye movements)

  • Tremor

  • Vomiting

  • Weight gain

NOTE: These medications should not be stopped abruptly. Please check with your provider before discontinuing use.


Anti-depressant Medications

How They Work:What They Treat:Possible Side Effects:

Anti-depressant medications are thought to work by affecting the levels of the brain's natural chemical messengers, called neurotransmitters, and adjusting the brain's response to them. Examples include: citalopram, amitriptyline, paroxetine and sertraline.

  • Anxiety

  • Bulimia (eating disorder)

  • Chronic pain

  • Depression

  • Insomnia

  • Headaches

  • Obsessive compulsive disorder

  • Panic disorders

  • Blurred vision

  • Cardiac palpitations

  • Confusion

  • Constipation

  • Dizziness

  • Drowsiness

  • Dry mouth

  • Gastrointestinal disturbance

  • Hypotension

  • Insomnia

  • Numbness

  • Seizures

  • Skin rash

  • Sweating

  • Tremor

  • Urinary retention

NOTE: These medications should not be stopped abruptly. Please check with your provider before discontinuing use.


Anti-psychotic Medications

How They Work:What They Treat:Possible Side Effects:

Anti-psychotic medications are a class of drugs used to treat psychosis and other mental and emotional conditions. One of the most frequently used medications in this class is quetiapine.

  • Aggression and agitation

  • Psychotic disorders

  • Schizophrenia

  • Sleep disturbances

  • Tourette's syndrome

  • Blurred vision

  • Dizziness

  • Dry mouth

  • Dystonia (a movement disorder)

  • Headache

  • Hypotension

  • Parkinsonism

  • Tremor

  • Urinary retention

  • Weight gain


Pain Management Medications

How They Work:What They Treat:Possible Side Effects:

Pain management medications are used to control pain stemming from TBI, and the symptoms and effects related to the injury. Examples include: acetaminophen, ibuprofen, and naproxen sodium.

  • Arthralgia (joint pain)

  • Fever

  • Headache

  • Mild to moderate pain

  • Myalgia (muscle pain)

  • Burning sensation

  • Constipation

  • Dizziness

  • Gastrointestinal irritation and bleeding

  • Heartburn

  • Nausea

  • Reye's syndrome (a rare but serious condition that causes swelling in the liver and brain)

  • Sedation

  • Tingling sensation

  • Vomiting

NOTE: Overuse of over-the-counter and herbal pain medications may actually aggravate the condition. Be sure that your provider is aware of all of the nonprescription meds that you are taking. Narcotics are not appropriate for pain management in TBI cases.


Motor System Medications

How They Work:What They Treat:Possible Side Effects:

These medications act on the motor system to affect the chemical balance in the brain, in an effort to control bodily movement. Examples include: baclofen, tizanidine or cyclobenzaprine.

  • Muscle spasms

  • Muscle spasticity

  • Parkinson's disease

  • Abdominal cramps

  • Chest pain

  • Confusion

  • Constipation

  • Depression

  • Diarrhea

  • Dizziness

  • Dyskinesia (impairment of movement)

  • Euphoria

  • Fatigue

  • Headache

  • Muscle weakness

  • Nasal congestion

  • Nausea

  • Psychotic episodes

  • Vomiting


Memory and Cognition Medications

How They Work:What They Treat:Possible Side Effects:

These medications act to block enzymes in the brain. These drugs are used to treat dementia, such as that found with Alzheimer’s disease. Others are used to treat attention deficits and hyperactivity. They may improve memory, awareness, and the ability to take part in everyday life. Examples include: donepezil, modafinil and methylphenidate.

  • Alzheimer's disease

  • Memory problems

  • Attention problems

  • Abdominal cramps

  • Diarrhea

  • Elevation of liver enzymes

  • Nausea

  • Vomiting

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