⚠️ Case of a patient who inserted a nail in his head after suffering from severe case of migraine in hope to relieve the extreme pain. The patient apparently had a history of psychiatric disorders and was fortunate enough to survive the injury. As in closed head injury, intracranial pressure is likely to increase due to swelling or bleeding, potentially crushing delicate brain tissue. Most deaths from penetrating trauma are caused by damage to blood vessels, which can lead to intracranial hematomas and ischemia, which can in turn lead to a biochemical cascade called the ischemic cascade. A person with a penetrating head injury may be evaluated using X-ray, CT scan, or MRI (MRI can only be used when the penetrating object would not be magnetic, because MRI uses magnetism and could move the object, causing further injury). Surgery may be required to debride or repair the injury or to relieve excessive intracranial pressure.