Epidural Hematoma: What Causes It, How It's Diagnosed, and How Long Recovery Takes — A Complete Guide
Updated: 4 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 17, 2026
Quick Answer
An epidural hematoma is bleeding that collects between the skull and the dura mater, usually from a torn artery after a skull fracture, pressing on the brain. Classic symptoms are a brief loss of consciousness, a lucid period, then worsening headache and confusion. It is a medical emergency that usually requires surgery, and outcomes are best when treated quickly.
What the research says
Epidural hematomas are common after head injury, and timely surgery is linked to favorable outcomes. A meta-analysis of 49 studies found epidural hematomas in 8.2% (95% CI 5.9–11.2) of traumatic brain injury patients, with an operative rate of 76.0% (55.5% after adjustment for small-study effect). Reported mortality was 5.3% without surgery and 8.3% with surgery, and the authors noted that people with isolated epidural hematomas who get timely surgery often have favorable outcomes (PubMed: Rahimi et al., Clin Neurol Neurosurg, 2022).
Some bleeds in the back of the skull are managed without surgery, but the evidence is thin. A systematic review and meta-analysis of 24 studies covering 874 patients with posterior fossa epidural hematoma — a rare type found in under 3% of head injuries — reported higher good-recovery (GOS 5) scores and lower mortality with conservative management. Those patients were more often the ones with higher alertness scores (GCS 13–15), and the authors called for randomized trials (PubMed: Daoud et al., Neurochirurgie, 2024).
What Is an Epidural Hematoma?
An epidural hematoma (EDH) is a collection of blood between your skull and the dura mater, the thick membrane that covers your brain.
Your brain has three membrane layers, called the meninges, that sit between your bony skull and your brain tissue. The meninges cover and protect your brain and spinal cord, and the dura mater is the outermost layer.
If you have an EDH, a blood vessel — usually an artery but sometimes a vein — has torn, and blood is leaking into the space over the dura mater. That leaking blood forms a pocket that bulges out and puts pressure on your brain. This pressure can cause more brain injury.
If bleeding occurs within the spine instead of the skull, it is called a spinal EDH. EDH is also known as an extradural hematoma, epidural hemorrhage, or intracranial hematoma. More broadly, it is a type of traumatic brain injury (TBI).
Quick fact | Detail |
What it is | Blood collecting between the skull and the dura mater |
Usual source | A torn artery, most often the middle meningeal artery after a skull fracture; occasionally a vein |
How common | Up to 10% of people with head injuries; about 75% of adult cases are in the temporal area |
Who it affects | Mostly young people; rare before age 2 or after age 60; four times more likely in males |
Classic pattern | Brief loss of consciousness, a lucid interval lasting hours, then decline |
How serious | Death in up to 15% of cases |
Main treatment | Usually emergency surgery to relieve pressure on the brain |
How serious is it?
An epidural hematoma can be a life-threatening condition. It usually requires immediate treatment, and if it is left untreated, it can cause brain damage or possibly death. An EDH results in death in up to 15% of cases.
Who is at risk?
Anyone who has a head injury can develop an epidural hematoma, but they are more commonly seen in young people and specifically more often in people who have experienced a skull fracture. Typical head injuries occur during athletic activities such as snowboarding, skateboarding, and biking, and from car or motorcycle accidents.
Factor | What the evidence shows |
Most common age range | Young people; rare before age 2 or after age 60 |
Sex | Four times more likely in males than in females |
Main link | Skull fracture |
Common activities involved | Snowboarding, skateboarding, biking, car and motorcycle accidents |
How common is it?
Epidural hematomas occur in up to 10% of people with head injuries. About 75% of EDHs in adults happen in the temporal area of the brain — the side of your head over your ear.
Symptoms: What Does an Epidural Hematoma Feel Like?
When a person has an epidural hematoma, they experience a brief loss of consciousness after the head trauma. This is followed by a period of alertness that may last for several hours — often called a lucid interval — before a second loss of consciousness and a decline in brain function. In some people, the loss of consciousness leads to coma. Most, but not all, people with EDH follow this symptom pattern.
Other signs and symptoms, which occur minutes to hours after the head injury, include:
Symptom | What you may notice |
Severe headache | Intense, worsening head pain |
Nausea and vomiting | Feeling sick to the stomach, sometimes with vomiting |
Enlarged pupil in one eye | The black center area of one eye is visibly bigger |
Confusion | Disorientation, difficulty thinking clearly |
Slurred speech | Trouble forming words clearly |
Dizziness | Feeling unsteady or off-balance |
Weakness on one side of the body | Reduced strength or movement on one side |
When pressure keeps building
If left untreated and the bleeding continues, brain pressure increases and symptoms can get worse. At that point, possible symptoms include:
Escalating symptom | What it means |
Seizures | Uncontrolled electrical activity in the brain |
Breathing problems | Pressure affecting vital brain centers |
Loss of brain function | Declining ability to think, move, and respond |
Coma | Prolonged unconsciousness |
Death | The most severe outcome when untreated |
Head to your nearest emergency room or call 911 (or your local emergency number) for any severe headache, seizure, breathing problem, or loss of consciousness after a head injury. Sudden changes are the hallmark of a growing brain bleed.
Causes: What Causes an Epidural Hematoma?
An epidural hematoma is usually caused by a head injury. A skull fracture occurs in 75% of the cases, and a skull fracture that tears the middle meningeal artery is the most common source of bleeding. Occasionally, an EDH can form from bleeding from a vein.
Non-trauma causes include infection or abscess, coagulopathy (blood that does not clot normally), hemorrhagic tumors, and vascular malformations such as arteriovenous malformations and cavernous malformations.
Situation | Most common cause |
With head injury | Skull fracture tearing an artery (usually the middle meningeal artery); occasionally a torn vein |
Non-trauma causes | Infection or abscess; coagulopathy; hemorrhagic tumors; vascular malformations |
Spinal epidural hematomas: a different cause pattern
Spinal epidural hematomas are most commonly spontaneous bleeds from veins caused by coagulopathies or by over-thinning of your blood from anticoagulant medications. Other causes include a fracture to the bones in your vertebrae, a lumbar puncture (spinal tap), epidural anesthesia, spinal arteriovenous malformations or other vascular abnormalities, spinal tumors, and pregnancy.
Cause of spinal EDH | How it leads to bleeding |
Coagulopathy or anticoagulant medications | Blood does not clot normally; over-thinned blood leaks from veins |
Vertebral fracture | Bone injury causes bleeding around the spinal cord |
Lumbar puncture or epidural anesthesia | Medical procedures near the spinal space |
Spinal vascular malformations | Abnormal blood vessels that can rupture |
Spinal tumors | Tumors that cause bleeding |
Pregnancy | A less common but recognized cause |
Diagnosis: How Is It Diagnosed?
An epidural hematoma is diagnosed using computed tomography (CT) or magnetic resonance imaging (MRI) of your head or spine. In the head, a hematoma appears as a dense mass that pushes the brain away from the skull.
An angiogram may be ordered if a non-trauma cause — like an arteriovenous malformation — is suspected. Blood work may be taken to look for factors that may increase your bleeding risk and to check for medical problems showing your blood has difficulty clotting.
Test | What it does |
CT scan of head or spine | Shows the blood collection; in the head, it appears as a dense mass pushing the brain away from the skull |
MRI | Detailed imaging of the head or spine |
Angiogram | Used if a non-trauma cause such as an arteriovenous malformation is suspected |
Blood work | Checks clotting function and bleeding-risk factors |
Epidural hematoma vs. subdural hematoma
These two brain bleeds are easy to confuse, but they differ in important ways.
Difference | Epidural hematoma | Subdural hematoma |
Location | Between the skull and the outermost meninges layer, the dura mater | Between the dura mater and the second meninges layer, the arachnoid |
Ease of diagnosis | Usually easier — sudden and obvious, typically associated with a skull fracture | Harder to identify; may not be evident after a single blow |
Prevalence | Less common | More common |
Death rate | Lower | Significantly higher |
Treatment: How Is It Treated?
An epidural hematoma is usually a medical emergency that requires immediate treatment. Signs you need surgery include the presence of a severe headache, a decrease in brain function, and a hematoma that is larger than the size of a pea at its thickest point. Without surgery to relieve pressure on your brain, permanent brain injury or death can result.
Surgery
The preferred surgery is a craniotomy and hematoma evacuation. This means removing a piece of your skull, removing the blood clot, stopping any obvious sites of bleeding, then putting the skull bone back in place and securing it with tiny screws.
Another surgical approach is to drill one or more holes in your skull to drain the blood. Draining relieves the pressure the blood buildup causes on the brain. The drain may be left in place for several days following surgery to allow the blood to continue draining.
If you have a spinal epidural hematoma, a laminectomy may be performed. During a laminectomy, a small section of bone is removed, which relieves pressure on your spinal cord and nerve roots caused by the blood clot.
Surgical approach | How it works |
Craniotomy and hematoma evacuation | Removes a piece of skull, removes the clot, stops bleeding, replaces the bone with tiny screws |
Burr-hole drainage | Drills holes in the skull to drain blood; the drain may stay in place for several days |
Laminectomy (spinal EDH) | Removes a small section of bone to relieve pressure on the spinal cord and nerve roots |
No surgery: conservative treatment
Sometimes small brain bleeds that are not causing pressure on the brain and only cause mild symptoms can be managed without surgery. Your body can absorb a small amount of blood over time, usually a few months. If you have a small brain bleed, you will be closely monitored with repeat head CT scans to make sure the hematoma is healing.
Medications
After surgery, your neurologist or neurosurgeon may prescribe medications to reduce inflammation and pressure within your brain. Medications that may be prescribed include mannitol, hypertonic saline, and glycerol. An antiseizure medication may also be prescribed for some time, since seizures are sometimes a complication of head injuries.
Rehabilitation therapy
If you have experienced brain damage, your neurologist will order the needed therapy — physical therapy, occupational therapy, and/or speech therapy.
Complications of surgery
Complication | What happens |
Infection | Wound infection at the incision, or deeper infections including meningitis or osteomyelitis |
Brain herniation | Increased pressure squeezes brain tissue out of its normal position; often leads to death |
Bleeding | Superficial or deeper; may form a repeat hematoma that requires removal again |
Seizures | May develop even after the hematoma has been treated |
Brain or spinal cord damage | Evident by weakness, numbness, and/or paralysis |
Coma or death | The most severe outcomes |
Outlook: What Can I Expect?
The outcome of an epidural hematoma varies greatly from person to person. Factors that affect outcome include your level of consciousness immediately after the head injury and upon hospital arrival, the amount of time that has passed between the injury and treatment, your eye (pupil) response and eye movement, your verbal response, your physical response, and your age.
In general, if you have a typical EDH, your prognosis is good if the hematoma is discovered quickly and removed and you have not slipped into a coma. EDHs caused by a bleeding artery develop rapidly and can be found quickly. EDHs caused by a tear in a vein develop more slowly, which can delay finding and treating them. The larger the size of the hematoma, the lower the odds of a good outcome.
Factor | Better outlook | Lower odds |
Consciousness after injury | Alert when arriving at hospital | Deeply impaired or comatose |
Time to treatment | Diagnosed and removed quickly | Delayed diagnosis (slow venous bleeds) |
Hematoma size | Small | Large |
Age | Younger patients generally fare better | Older patients generally fare worse |
Prevention: Can It Be Prevented?
Although it may not be possible to prevent a hematoma as a result of a motor vehicle accident, you can reduce your risk by protecting your head when it is an option.
Prevention step | Why it helps |
Always wear a helmet when riding a bike or motorcycle, skateboarding, or snowboarding | Protects the skull during high-risk activities |
Don't dive into water that is not 100% free from rocks | Prevents head impact in shallow or rocky water |
Wear appropriate headgear for high-impact or contact sports | Reduces the chance of skull fracture |
Use safety gear if you work off the ground or at a job with high head-injury risk | Protects against falls and impacts |
Always wear your seatbelt | Reduces head injury in vehicle accidents |
When to Seek Emergency Care
All blows to the head should be considered a serious event. If you or a loved one hit your head, get it checked at a hospital. Call 911 or seek medical attention immediately if you or someone you know has any of the following after a head injury:
Emergency sign | What to look for |
Loss of consciousness | A friend or witness needs to call 911 |
Severe headache | Intense, unusual head pain |
Slurred speech | Trouble forming words |
Confusion | Disorientation |
Nausea or vomiting | Feeling sick after the injury |
Change in alertness or drowsiness | Getting progressively harder to rouse |
Enlarged pupil or unequal pupils | One black center area bigger than the other |
Dizziness | Unsteadiness |
Double vision | Seeing two of everything |
Weakness or numbness anywhere | Any part of the body |
Seizures | Convulsions or uncontrolled movements |
Questions to Ask Your Provider
Talking about head injuries and brain bleeds can feel overwhelming, especially after an emergency. Here are questions worth asking — the answers help you understand your treatment plan and what to expect.
Question | Why it helps |
How serious is my bleed? | Establishes whether surgery is needed |
Will I need surgery, and which approach? | Sets expectations for craniotomy, drainage, or monitoring |
How long will recovery take? | Helps plan rehabilitation and follow-up |
What symptoms mean I should go back to the ER? | Catches rebleeding or pressure early |
Do I need rehabilitation therapy? | Determines whether PT, OT, or speech therapy is needed |
Should I avoid certain medications or activities? | Reduces rebleeding risk, especially with anticoagulants |
Key Takeaways
An epidural hematoma is bleeding that collects between your skull and the dura mater, the outermost membrane covering your brain. It is usually caused by a skull fracture that tears an artery — most often the middle meningeal artery — and the blood pocket presses on the brain, causing severe headache, loss of consciousness, and declining brain function. It occurs in up to 10% of people with head injuries, is four times more common in males, and results in death in up to 15% of cases. The classic warning pattern is a brief loss of consciousness followed by an alert period, then a rapid decline — and the prognosis is good when the bleed is found quickly and relieved surgically.
Take the Next Step
Treat every significant blow to the head as a serious event. If you or someone you know develops a severe headache, unequal pupils, confusion, slurred speech, weakness on one side, vomiting, drowsiness, or seizures after a head injury, call 911 or go to your nearest emergency room immediately — minutes matter when pressure is building on the brain. If you play contact sports, ride a bike or motorcycle, skateboard, or snowboard, always wear protective headgear, and always wear your seatbelt.
Further reading: Brain Injury Association of America — Understanding Traumatic Brain Injury · NINDS — Traumatic Brain Injury · AANS — Epidural Hematoma
Frequently Asked Questions
1. What is an epidural hematoma?
An epidural hematoma is a collection of blood between your skull and the dura mater, the outermost membrane covering your brain. It is usually caused by a skull fracture that tears an artery, and the blood pocket presses on your brain.
2. How serious is an epidural hematoma?
An epidural hematoma can be life-threatening. It usually requires immediate treatment and can cause brain damage or death if left untreated. It results in death in up to 15% of cases.
3. What are the symptoms of an epidural hematoma?
The classic pattern is brief loss of consciousness after head trauma, then an alert period lasting hours, then declining consciousness. Other symptoms include severe headache, nausea and vomiting, an enlarged pupil in one eye, confusion, slurred speech, dizziness, and weakness on one side.
4. How common is an epidural hematoma?
EDHs occur in up to 10% of people with head injuries. About 75% of adult cases happen in the temporal area, on the side of the head over the ear.
5. What causes an epidural hematoma?
Usually a head injury with a skull fracture, which occurs in 75% of cases and most often tears the middle meningeal artery. Less commonly, infection, coagulopathy, hemorrhagic tumors, or vascular malformations cause it.
6. Does an epidural hematoma go away on its own?
Only small bleeds that are not causing pressure and cause only mild symptoms can be managed without surgery. The body absorbs small amounts of blood over a few months, with close CT monitoring. Larger or symptomatic bleeds require surgery.
7. How is an epidural hematoma treated?
Usually with emergency surgery: a craniotomy to remove the blood clot and relieve pressure, or drilling holes to drain the blood. Spinal cases may need a laminectomy. Medications reduce brain pressure, and rehabilitation therapy follows if brain damage occurred.
8. How long does recovery take?
It varies greatly depending on consciousness level after injury, time to treatment, and hematoma size. The prognosis is good if discovered quickly, removed, and no coma occurred. Small monitored bleeds take a few months to absorb.
9. What is the difference between an epidural and subdural hematoma?
An epidural hematoma occurs between the skull and the dura mater, while a subdural hematoma occurs between the dura mater and the arachnoid layer. EDHs are easier to diagnose and less common, while subdural hematomas are more common and have a significantly higher death rate.
10. When should I go to the ER after a head injury?
Call 911 or seek immediate care for loss of consciousness, severe headache, slurred speech, confusion, nausea or vomiting, drowsiness, an enlarged or unequal pupil, dizziness, double vision, weakness or numbness anywhere, or seizures.
11. How can I prevent an epidural hematoma?
Wear a helmet when biking, motorcycling, skateboarding, or snowboarding; wear headgear for contact sports; use safety gear at high-risk jobs; avoid diving into water that may contain rocks; and always wear your seatbelt.
Related Reading
References
Cleveland Clinic. Epidural Hematoma. Cleveland Clinic. Last updated Sept. 30, 2026. https://my.clevelandclinic.org/health/diseases/22034-epidural-hematoma
Rahimi A, Corley JA, Ammar A, et al. The unmet global burden of cranial epidural hematomas: a systematic review and meta-analysis. Clin Neurol Neurosurg. 2022;219:107313. doi:10.1016/j.clineuro.2022.107313. PMID: 35688003.
Daoud SS, Jamous MA, Al Barbarawi MM, et al. Operative versus non-operative management of posterior fossa epidural hematoma: a systematic review and meta-analysis. Neurochirurgie. 2024;70(5):101578. doi:10.1016/j.neuchi.2024.101578. PMID: 38943702.
Aromatario M, Torsello A, D'Errico S, et al. Traumatic epidural and subdural hematoma: epidemiology, outcome, and dating. Medicina (Kaunas). 2021;57(2):125. doi:10.3390/medicina57020125. PMID: 33535407.
Khairat A, Margetis K, Waseem M. Epidural Hematoma. In: StatPearls. Treasure Island (FL): StatPearls Publishing; updated July 7, 2025. https://www.ncbi.nlm.nih.gov/books/NBK518982/
Medical Disclaimer
This article is for informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read here.
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