Forehead Bump After Injury: Treatment Options & When to See a Doctor
A forehead hematoma ("goose egg") is common after trauma. Most are benign, but some signal serious injury.
Immediate Assessment
- Mechanism: Fall, MVC, assault, sports — high force = higher concern
- LOC: Any loss of consciousness? Amnesia? Confusion?
- Vomiting: >1 episode worrisome
- Neuro deficits: Pupil asymmetry, weakness, speech, vision changes
- Age: <2 yr or >65 yr = lower threshold for imaging
- Anticoagulants: Warfarin, DOACs, antiplatelets = higher bleed risk
When to Seek Emergency Care
- Any LOC, confusion, repeated vomiting, seizure
- Worsening headache, drowsiness, difficulty waking
- Clear fluid from nose/ears (CSF leak)
- Bruising behind ears (Battle’s sign) or around eyes (raccoon eyes)
- Skull deformity, penetrating wound
- On blood thinners with any head trauma
Imaging Indications (Canadian CT Head Rule / New Orleans Criteria)
- GCS <15 at 2h post-injury
- Suspected open/depressed skull fracture
- Basilar skull fracture signs
- >1 vomiting episode
- Age ≥65
- Amnesia >30 min
- Dangerous mechanism (MVC ejection, fall >3 ft/5 stairs)
Management by Severity
| Severity | Treatment |
|---|---|
| Minor hematoma, no red flags | Ice 20 min on/off (cloth barrier), OTC analgesia (acetaminophen preferred — avoid NSAIDs if bleed risk), observe 24h for changes |
| Large hematoma, no neuro signs | Same + consider US/CT if expanding. Aspiration rarely needed (infection risk). |
| Skull fracture, no neuro deficit | Admit for observation. Most heal without surgery. |
| Intracranial bleed (epidural, subdural, subarachnoid, intraparenchymal) | Neurosurgical consult. Craniotomy/craniectomy if mass effect, herniation risk, progressive deficit. |
| Depressed skull fracture | Elevation if >depth of skull table, contamination, neuro deficit, cosmetic. |