Head Injuries and Strangulation Hurt Your Brain

Violence directed at the head, neck, and face—including choking and strangulation—can have serious and long-lasting consequences. Often people are hurt again and again without medical care, treatment, or time to heal.
This material is not intended to diagnose any medical issues. If you have questions or concerns or think you might have had a brain injury talk to a doctor. To help connect with a doctor reach out to your local domestic violence program.
I have recently been hurt

If you are in immediate danger, call 911.

  • Being hurt by your partner is really scary, and we are sorry that it happened to you. It’s not your fault and you are not alone.
  • If possible, take pictures of your injuries to document progression.
  • If possible, stay with someone safe for 72 hours (about 3 days) to look for signs or symptoms you may not be aware of, or to call 911 for any life-threatening emergencies.
  • There are people who care about you and help is available, including support at the National Domestic Violence Hotline. They can connect you to a local domestic violence program that provides free and confidential services. Your local domestic violence program can help you with somewhere safe to stay or a safety plan, talk with you about the risk of deadly violence from your partner, and can connect you to community resources.
Do I need immediate medical care?

If you are experiencing any of these things, get medical care immediately and tell them that you have recently been hit or hurt in the head, and/or choked or strangled.

  • Difficult and/or painful breathing (especially after choking/strangulation)
  • Uncontrollable vomiting
  • Shaking or twitching (seizures)
  • Confusion or uncontrollable agitation
  • Drowsy or cannot wake up
  • Excruciating headaches
  • Slurred speech, weakness, numbness
  • Decreased coordination or problems using arms or legs
  • One pupil (the dark part of your eye) is larger than the other
  • Peed or pooped unintentionally (especially after choking/strangulation or other loss of consciousness)
  • Passing out, blacking out, or loss of consciousness
    • Losing consciousness is a common symptom of strangulation and other head trauma. You may not know if you lost consciousness, and you will likely not know for how long you were out.
    • Things to notice: Did you wake up in a different room than you remember starting in? Were you bathed or showered, or with a new change of clothes when you came to
    • Just before the assault, do you remember if it was sunny or dark out, and did that change when you came to? Do you remember if anything was on the TV or radio and what was on when you came to that could indicate the passage of time?

Ten Things to Know About the
Connection Between Brain Injury and Violence

#1 - See a doctor and stay with someone safe

This is especially true if you are pregnant or if you or someone else is worried about your health. If possible, stay with someone safe for at least three days to watch for signs or symptoms that need immediate medical care, like the ones listed above. Signs of brain injury can occur days, weeks, and even months after your head has been hurt. Be aware and notice any changes in your physical or mental health.

The violence you experienced might have caused a concussion or brain injury, and it will heal more quickly if it’s identified and treated.  Tell your doctor that you were hurt in the head or choked or strangled, as well as any signs and symptoms you are noticing. 

#2 - Violence causes traumatic brain injuries (also known as concussions)

A traumatic brain injury happens when there is a change to how your brain normally works due to a bump, blow, or jolt to your head. Because your brain plays a role in everything your body does, it can have a huge impact on your life for a long time. Concussions can occur from a minor bump, and you don’t need to be knocked out to experience a concussion. 

You don’t need to have any marks, bruises, swelling, or obvious signs of damage for your brain to be hurt. Just like broken arms, brains need time to heal. After your head has been hurt, it’s normal to feel like you are in a fog or it’s hard to think, or that it’s hard to do things like you used to.  

Common causes of brain injuries related to violence can include but are not limited to: 

  • A blow to your face or head, like being punched or hit in the head with something
  • Being headbutted
  • Having your head slammed against something
  • Falling and banging your head
  • Being shaken severely

Traumatic brain injuries can also be caused by other things not related to violence, such as vehicle crashes, sports accidents, or any type of slipping or falling when someone hits their head. 

#3 - Choking and strangulation cause brain injuries

Anything that happens to you that makes it hard to breathe can hurt your brain. Our brains weigh about 2% of our body but use 20% of our oxygen and need a constant flow of oxygen to function. When our brain is deprived of oxygen, it causes damage very quickly and kills brain cells, so the brain doesn’t work how it should. It does not take a lot of pressure on your neck to restrict oxygen to your brain and you can lose consciousness within seconds.

Some of the ways in which the brain can’t get oxygen are when someone: 

  • Puts their hands or something else around your neck or throat and you feel choked or strangled or can’t breathe
  • Sits on your chest or back
  • Puts their hands or something else over your mouth and nose so you can’t breathe and you feel suffocated
  • Puts you in a chokehold
  • Chokes or strangles you during sex–which can cause long-lasting brain damage

While many people use choking and strangulation as two words for the same thing, they aren’t. Choking is when something blocks your airway, and you can’t breathe—like a piece of food. Strangulation (choking) is when someone puts their hand or anything else on or against your neck. Suffocation is when something is put over your face making it hard to breathe.

#4 - People who choke or strangle are dangerous

Being choked, strangled, or suffocated is a terrifying experience.

Strangulation is the ultimate act of power and control. People who choke or strangle their partners are more likely to kill their partners. When people strangle their partners, it’s often a sign that the violence is getting worse and more severe. Being choked or strangled has significant short-term and long-term consequences for both your physical and mental health.

Some examples of other things that put you more at risk include having access to a gun, forced sex, threats to kill you or your children, controlling your daily life, and problematic drug and alcohol use. Contact a domestic violence program to plan for your safety and review other issues that increase your risk for lethal violence.

#5 - Any head trauma or strangulation is a big deal, especially if it has happened more than once

According to many experts in the field, while some brain injuries are less serious than others, there is no such thing as a “minor” concussion or brain injury. And most domestic violence victims are assaulted in the head, neck, and face, and choked or strangled multiple times. Sometimes people are hurt over and over in one terrifying attack. After your brain has been hurt, even a less severe assault (such as being slapped across the face) can exacerbate a previous injury and cause significant damage.  

Any time you are hurt in this way, it should be taken seriously. Be sure to monitor any injuries or differences in your physical or mental health.

#6 - The impacts of brain injury might not show up right away

One of the difficult realities of brain injuries is that the impact often does not show up immediately after you are hurt, but can manifest weeks, months, or even years after a brain injury.  You may not know how the injury affects you until later, but problems can continue for weeks and even years after a brain injury—especially when unidentified and unaddressed.

Common signs/symptoms can include, but are not limited to: 

Physical problems: Headaches, sleeping problems, sensitivity to light or noise, vision problems, dizziness, balance problems, fatigue, seizures. 

Emotional problems: Worries and fears, panic attacks, flashbacks, sadness, depression, hopelessness, anger or rage, irritability, inability to control emotions or reactions.  

Problems with thinking: Remembering things, multi-tasking, paying attention or focusing, problem-solving, getting things started, figuring out what to do next, and organizing things. 

Many signs of brain injury overlap with other physical and mental health conditions including traumatic stress, which can accompany brain injuries from violence. It is important to talk to your doctor about your head injury and the signs and symptoms you experience.

#7 – Even if you were hurt a long time ago, brain injury could still be affecting your life

Some longer-term impacts can include: 

  • Changes in personality
  • Problems with thinking tasks, such as memory, organization, prioritizing things, or multi-tasking
  • Problems on the job or maintaining employment due to cognitive challenges
  • Persistent health problems that you can’t figure out
  • Consistent problems with thinking tasks such as memory, organization, prioritizing things, multitasking
  • Problems that prevent you from living your life how you want to, like fatigue, sleep issues, worsened mental health, or inability to manage your complex life
  • Challenges doing something that you used to be able to do well

#8 - Medical imaging may not show brain injury—and there are other ways to diagnose them

While tests such as MRI or CT scans can sometimes show evidence of a brain injury, there is no medical imaging test that is 100% accurate in diagnosing a brain injury.

Sometimes brain injuries that occur from severe blunt force trauma, such as in a car accident, do show up. But brain cells that are very small are often damaged after a brain injury, as well as the connections between brain cells, which don’t show up on imaging exams.

Even if you have some type of scan and it comes back negative, your brain could still have been impacted. There are several other types of screenings, tests, and evaluations used by trained medical professionals to assess for concussion or brain injury.

All brain injuries, including concussions, need to be diagnosed by a qualified medical professional. 

#9 - Things you can do if you think you have a brain injury

Only a qualified medical professional can diagnose a brain injury, so one of the first steps is to discuss this with a medical provider. 

If you think you might have a brain injury, write down your observations of the problems you are having, how frequently they are happening, and how it impacts your life. Consider asking trusted friends or family if they have noticed any changes—because sometimes others notice things we don’t. Writing down this information and then sharing it with a doctor, therapist, or another person who is helping you is a good first step.

#10 – After a brain injury, you CAN live a fulfilling life

Brain injuries can get better, and there is a lot you can do so brain injuries are less disruptive to your life. You can live a good life, even with a brain injury.

It is difficult to address something that has not been identified, so acknowledging that your brain may have been hurt is a significant first step. Many survivors find it empowering and relieving to know that some of their challenges and limitations could be related to something that someone else did to them, as opposed to something that is their fault. Many survivors state this helps them understand their limitations differently and that education and information about brain injury helped them realize they aren’t crazy or stupid.

Brain injury might continue to impact your life for a long time and even forever. But just like any other health condition, knowing how it impacts you can only help you to manage it better and make it less disruptive in your life. You CAN go on to live a fulfilling life where you are treated with the love and respect you deserve and take this knowledge of how domestic violence has impacted you into your future. No one can rewrite the past, but we all can help write a better future.

Common Challenges Related to Brain Injury
and Ideas to Help You Manage Them

Nightmares, flashbacks, anxious, or withdrawn

Manage by:

  • Focus on your breath. Breathe in and out slowly to help your body calm down.
  • Distract yourself by doing something you enjoy, like listening to music, going for a walk, or doing an art project
  • Talk to someone for support; like a trusted friend, family member, advocate, or counselor
  • Learn more about common reactions to trauma and relaxation strategies

Trouble remembering things, planning, or organizing

Manage by:

  • Use organizational tools, planners, or apps to keep important dates and information, including to-do lists, calendars, and important numbers.
  • Set a central location to always put important things, such as phones, keys, wallets, and glasses.
  • Follow a routine and come up with associations, such as always taking medication with breakfast, or always checking appliances before bed.
  • Use a timer or alarm to help you get started and work on something for a set time
  • Take frequent breaks, especially if you feel frustrated

Sensitivity to light or sound, or vision problems

Manage by:

  • Use earplugs, headphones, and sunglasses, or adjust lighting as possible
  • Adjust text size and volume settings on your technology
  • Consider contacting an eye doctor if vision issues persist
  • Reduce your screen time
  • Take frequent breaks
  • Work where it is quiet with minimal distractions

Difficulty understanding information, problem-solving, or concentrating

Manage by:

  • Ask people to speak slowly
  • Re-read/review the information multiple times
  • Have shorter meetings, activities, or conversations
  • When problem-solving, write down several ideas and talk them over with someone you trust
  • Break down large tasks into smaller steps.
  • Focus on one thing at a time

Connect with a brain injury specialist

If you are in Ohio

Connect with the Brain Injury Association of Ohio Helpline at 833-783-1495


If you are not in Ohio:

Connect with the BIAA’s National Brain Injury Information Center at 800-444-6443.

Find your statewide Brain Injury Association.

This project is supported by Grant No. 2020-FW-AX-K001 “Education, Training, and Enhanced Services to End Violence Against Women with Disabilities Grants Program” awarded by the Office of Violence Against Women, U.S. Department of Justice. The opinions, findings, and recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the Department of Justice, Office on Violence Against Women.

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