OBJECTIVE: To present an update on head injury with a review of the literature. The authors emphasize the importance of the secondary brain injury prevention and describe the basic principles of the treatment, from the site of the accident to the intensive care unit.METHODS: Papers and abstracts from the database Lilac in the period between 1984 and 1999 and Medline between 1995 and 1999 were reviewed as well as textbooks and the Guidelines of the American Brain Trauma Foundation 1995.CONCLUSIONS: Despite the vast literature on the subject there have been many controversies regarding the therapeutic proposals. Prospective studies will be required in order to verify their efficacy. Nevertheless, the prevention and treatment of the secondary brain injury has been shown to be effective in reducing the disability and mortality of the patient with head trauma.