Traumatic Brain Injury (TBI) Recovery: What to Expect After a Head Injury

Traumatic brain injury (TBI) is damage to the brain after trauma to the head. Recovery from TBI is a process that takes time. That process will vary from person to person depending on how severe the injury is. But there are things you can do to reduce complications and improve your chances of recovery. 

Complications after traumatic brain injury

People with mild TBI usually recover over time, but they must be very careful to avoid repeat injuries. If someone has another serious head injury before they recover, it can worsen quickly and cause severe brain swelling. 

This is “second impact syndrome,” and it can be so serious it leads to death. Athletes who return too soon after a concussion are at high risk for second impact syndrome.

Mild TBI that keeps happening over time can give rise to more serious issues. This is chronic traumatic encephalopathy (CTE). CTE is more common in people who have repetitive injuries. People at high risk include those who play football, ice hockey, soccer, and rugby. Boxers and those in active duty also have a high risk.

Ongoing symptoms of CTE can include:

• Memory problems

• Speech problems

• Decreased coordination

• Attention deficits

• Suicidal behaviors 

Mental and behavior changes with TBI

After TBI there can be changes in how you think, understand, and behave. These complications may include:

• Agitation

• Disorientation

• Mood changes

• Aggressiveness

• Impulsivity and irritability

• Poor judgment

• Trouble communicating

• Slow thinking

• Difficulty concentrating

• Post-traumatic stress disorder (PTSD)

• Amnesia (memory problems)

If you have amnesia after a TBI, you may not recall events before or after the injury. That’s because the memory connections in the brain get altered as a result of TBI. You may forget events that happened right before the injury (retrograde amnesia). Or you may have trouble forming new memories of facts or events after the injury (anterograde amnesia).

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Medical complications after TBI

In addition to behavior changes, TBI can have medical consequences. This is more likely to occur with moderate or severe TBI. 

Medical complications in early stages after moderate or severe TBI may include:

• Infections

• Increased blood pressure, heart rate, and body temperature

• Hydrocephalus (abnormal buildup of brain fluid)

• Deep vein thrombosis (DVT)

• Wounds (skin breakdown and ulcers)

• Pituitary gland disorders (like diabetes insipidus)

Long-term medical complications after TBI include:

• Headaches (may continue up to 1 year after injury) 

• Seizures 

• Depression

• Anxiety 

• Heterotopic ossification (abnormal bone formation usually in the hip or knee in TBI)

• Spasticity (abnormal increase in muscle tone) 

Over half of people with severe TBI develop post-traumatic epilepsy (PTE). Changes in the brain may include:

• Hemorrhage

• Scarring

• Lack of oxygen

• Swelling

• Inflammation

These changes lead to events that may continue to deteriorate the brain for months to years. In PTE, the brain circuits reorganize, causing a change in its electrical impulses. This can lead to seizures. 

Some people may have the first seizure many years after injury. If you have a family member with epilepsy, this increases your odds of PTE after TBI. 

How do you treat TBI?

Treatments to help recovery from TBI can vary. Some people with mild TBI may only need rest and pain medication, whereas people with severe TBI may need intensive care treatment.

For a serious TBI, treatment in the short term may include:

• Medical stabilization: The medical team will make sure there is proper blood flow, pressure, and oxygenation to the brain. Your provider may recommend inducing a coma. This will let the brain rest while it heals.

• Surgery: People with moderate or severe injuries may need surgery. Sometimes a surgeon will remove a bone flap from the skull to drain blood and release pressure in the brain. Or they may drill holes in the skull bones and place a catheter.

Some medications may help treat symptoms and complications after TBI. In long-term recovery, you may need treatment for:

• Headaches: Treatment may consist of physical therapy, nerve blocks, or injections. Some medications — such as divalproex, gabapentin, and amitriptyline — might also help.

• Seizures: Antiepileptic medications in the first week after injury may help prevent early seizures after TBI. But many develop PTE later on. Medications may include levetiracetam, phenytoin, and lamotrigine, among others. But they don’t always work. 

• Depression: Medications like Celexa (citalopram) and Zoloft (sertraline) may help for depression. Positive environments may also improve emotional well-being.

• Behavior changes: You may need treatment for mood and behavior changes. For example, buspirone for stabilizing mood, modafinil for focus, and propranolol for aggression.

How long does it take to recover from traumatic brain injury? 

For mild TBI, recovery can happen in a matter of weeks. Sometimes recovery can occur months or even years after the injury. It will depend on the level of impairment from your injury. 

Recovery in severe TBI may begin with opening the eyes and regaining some movements and purposeful behaviors. Then, you may go through periods of confusion, agitation, and poor awareness. Improved memory and mobility along with a return to proper behavior means there is significant improvement.

Ongoing recovery can last for months to years. TBI survivors will likely need support as they seek to recover. This can include support from rehabilitation and social services after returning home.

Rehabilitation

People with TBI may need rehabilitation at a hospital or clinic. The type of therapy will depend on:

• Severity of symptoms

• Degree of mobility

• Ability to take part in therapies

• Medical stability

Rehabilitation includes physical and occupational therapy for mobility and activities of daily life. Speech and language therapists can help with any swallowing and speech problems. 

Treatment for difficulty swallowing includes:

• Changes in posture and position during swallowing

• Strengthening exercises

• Special swallowing techniques

• Electrical stimulation 

• Changes in food consistencies (more liquid, blended, mashed, or ground foods) 

Social services support

Once you return to the home environment after TBI, you may need some help going back to life roles. After the initial recovery, you may have an ongoing need for:

• Disability exams

• Vocational rehabilitation

• Driving tests

• Counseling

TBI survivors may also need to use mobility aids or other assistive devices. This can be an ongoing expense, but there are programs and financial assistance to help.

Family and caregivers should learn to cope with impairments and provide support when possible. It’s also important to be realistic on what to expect. 

How can traumatic brain injury affect you years after it occurs?

People with mild TBI tend to recover well. But some may continue to have memory problems. They’re also at risk of substance misuse and psychiatric disease.

Most people with moderate TBI recover fairly well, but about 25% will show some disability. In contrast, only about 25% of those with severe TBI recover well. And most will have a higher level of disability.

Experts consider TBI a chronic, lifelong health condition. People who have had moderate to severe TBI seem to have a shorter life span. 

TBI may have many neurological consequences. And, over the years, there can be further deterioration. Those who had a TBI may have higher chances of:

• Stroke

• Parkinson’s disease

• Alzheimer’s disease

• ALS (amyotrophic lateral sclerosis)

Why trust our experts?

Written by:

Itza Rivera, MD

Dr. Rivera is a board-certified physical medicine and rehabilitation specialist. She completed her medical degree and residency training at the University of Puerto Rico School of Medicine, and her neuromuscular disorders subspecialty training at Northwestern University.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

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