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 something related to your health. If you have someone safe you can stay with, do so 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 was hurt. It helps to be aware and notice changes in your health or mental health. The violence you experienced might have caused a concussion or another type of brain injury, and it will heal more quickly if it’s identified and treated. Remember only qualified medical professionals can diagnose a concussion or brain injury, and it helps to share with your doctor that you were hurt in the head or choked or strangled, as well as what type of signs and symptoms you are noticing.

#2 - There Are Many Ways People Can Get Brain Injuries

People are hurt in lots of different ways and it’s impossible to list all of them. It can be hard to get medical care after a brain injury, so brain injuries often go unidentified and unaddressed. Sometimes if your brain has been hurt, even a “minor” assault (such as being slapped across the face) can exacerbate a previous injury and make it worse.

Some common causes of brain injuries related to violence include:

  • A blow to your face or head, like being punched
  • Being headbutted
  • Being hit in the head with something
  • Having your head slammed against the wall or the floor
  • Falling and banging your head
  • You are shaken severely
  • Someone did something that made you pass out, lose consciousness, or have trouble breathing.

#3 - Violence Causes Traumatic Brain Injuries (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. Head injuries are also a result of the brain not getting the oxygen or blood it needs, like when someone strangles or chokes you or does something that restricts or disrupts your breathing. 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 even a minor bump, and you don’t need to be knocked out to experience a concussion.

Just like broken arms, brains need time to heal. After your head has been hurt, it might feel like your brain isn’t working right or that it’s hard to do things like you used to. This is normal when a brain has been hurt.

You don’t need to have any bruises, swelling, or obvious signs of damage for your brain to be hurt.

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.

#4 - 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 to restrict oxygen to our brain and you can lose consciousness within seconds. Some of the ways in which the brain can’t get oxygen are when someone:

  • Put their hands or something else around your neck or throat by choking or strangling you
  • Sat on your chest
  • Put their hand or something else over your mouth so you can’t breathe, and you feel suffocated
  • Put you in a chokehold
  • Choked or strangled you during sex—which can cause long-lasting brain damage

#5 - People Who Choke or Strangle are Dangerous

People who choke or strangle are dangerous and put you at higher risk of being killed.

People who choke or strangle their partner are around seven times more likely to kill you. Strangulation is the ultimate act of power and control and is terrifying to experience. 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 health consequences for both your physical and mental health. Reach out to a domestic violence program that can help plan for your safety and review other issues that increase your risk for lethal violence.

#6 - Brain Injuries Can Cause Many Problems

Problems with your physical or mental health, emotions, and thinking could be signs or symptoms of an unidentified brain injury.

A symptom is something you feel, that others might not notice unless you tell them. A sign is something others are able to see—that you may notice or not. Many signs and symptoms of brain injury overlap with other conditions—including traumatic stress, which always accompanies brain injuries from violence. It’s important to talk to a doctor to better determine the role your head trauma might play in the signs and symptoms listed below, including but 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, going from 0 to 100 very quickly.

Thinking problems: Remembering things, multi-tasking, paying attention or focusing, problem-solving, getting things started, figuring out what to do next, organizing things, controlling emotions or reactions.

#7 - Impacts from Brain Injury Might Not Show Up Right Away and Can Last a Long Time

Brain injury can impact you for a long time and make normal daily activities challenging, as well as cause other significant problems.

One of the difficult realities of brain injuries is that the impact of them often does not show up immediately after you are hurt, and can continue to manifest weeks, months, or even years after a brain injury. Some of the longer-term changes can include:

  • Changes in personality
  • Problems with maintaining employment due to cognitive challenges
  • Persistent health problems that often are hard to identify a cause or reason for
  • Consistent problems with thinking tasks such as memory, organization, prioritizing things, multitasking
  • Functional limitations 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 Always Show Brain Injury

While tests such as MRI or CT scans can sometimes show evidence of a brain injury, there is no imaging test that can always show evidence of brain injury.

There is no medical imaging test that can always accurately diagnose a brain injury. Often the damage to the brain happens to brain cells, which don’t show up on imaging exams. Sometimes brain injuries that occur from severe blunt force trauma, such as in a car accident, do show up. Most brain injury diagnoses, including diagnoses for concussions, are clinical diagnoses, which means that a doctor determines whether a concussion occurred as opposed to having some type of test (like a blood test, Covid test, or x-ray for a broken bone).

#9 - Things You Can Do If You Think You Have a Brain Injury

Remember that only a qualified medical professional will be able to diagnose a brain injury. A good place to start is to begin writing down observations and what types of problems you are having, how frequently they are happening, and how it’s impacting your life. Consider asking others who you know and trust 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 step.

#10 - You Can Have a Good Life, Even With a Brain Injury

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’s hard to address something that hasn’t 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 weren’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

Brain Injury Association of America

Speak to a local brain injury specialist by contacting BIAA’s National Brain Injury Information Center (NBIIC) at 1-800-444-6443.  To reach out to the Brain Injury Association in your state, click here to find your BIA.

HelpLine—The Brain Injury Association of Ohio 

Call 833-783-1495 to connect with The Brain Injury Association of Ohio Helpline.

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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