Fatigue after brain injury

Fatigue is experienced by everyone at some point after a period of physical or mental activity and is a signal from our bodies telling us to take a break. ‘Normal’ fatigue is time-limited and alleviated by rest, whereas ‘pathological’ fatigue, such as that experienced following brain injury, may be present most of the time. It may not improve with rest and is likely to significantly impact on people being able to do the activities they want to do.

This page provides an overview of fatigue, but you can find out more in our booklet Managing fatigue after brain injury (PDF), or by exploring the links at the bottom of the page.

What is pathological fatigue?

Fatigue is a personal experience that is different for everyone. For some it may feel like overwhelming tiredness, which makes them unable to complete normal activities of daily living.

People may say they feel exhausted, lacking in energy, weak, unable to motivate themselves, or sleepy. For others it may worsen difficulties associated with their injury, for example, forgetfulness, irritability, slurred speech, distractibility or dizziness.

Fatigue often makes resuming previous roles and daily activities more difficult and can contribute to people becoming socially isolated.

Therefore, fatigue may affect:

  • what we think (for example, “I shouldn’t feel like this, I’m useless”)
  • how we feel (for example, frustrated, unable to cope, irritable)
  • what we do (for example, avoiding activities, or increasing effort)

What causes fatigue after brain injury?

Many people experience fatigue following brain injury, but the underlying causes are still poorly understood.

Fatigue may be a result of direct damage to brain structures or due to other factors such as needing to make more effort to think or move. The brain system that appears to be linked to fatigue is the part that maintains alertness. This is known as the ascending reticular activating system (ARAS), and it links the brainstem with the thalamus, hypothalamus and cerebral cortex. The ARAS affects alertness by influencing the amount of information that the thalamus relays to conscious awareness.

Brain anatomy diagram shows the location of the brain stem, thalamus, hypothalamus and cerebral cortex, as discussed in the fatigue article

Research studies have shown that there are many different factors that make people vulnerable to experiencing fatigue and can affect how they respond to it. Some of the factors involved include:

Some of these factors may be managed more effectively to enable you to cope better with everyday activities that are important to you.

What are the signs of fatigue after brain injury?

In order to cope with fatigue you must first be able to recognise it. So how do you know when you are getting fatigued or fatigue is starting to build up?

Some signs may include:

  • yawning
  • losing concentration/attention
  • eyes feeling heavy, or eyesight blurring
  • head feeling ‘fuzzy’
  • fidgeting/getting irritable
  • limbs feeling heavy
  • stomach feeling sick

However, following brain injury it can be difficult to notice these signs. This may be due to problems with sensory feedback to the brain. What signs do you have that tell you that you are starting to get fatigued? How does it feel, what do you think and how do you behave? It may be helpful to ask your family and friends what signs they notice.

What triggers fatigue after brain injury?

Things that trigger fatigue will be different for everyone. Some examples of activities reported to be more tiring following a brain injury include:

  • working at a computer
  • dealing with paperwork/correspondence
  • being in a busy environment such as a shopping centre
  • concentrating on one conversation in a noisy place like a pub
  • driving or catching public transport

It may take time to work out what your triggers are, so fatigue might feel difficult to control. However, it is likely that certain activities are more tiring for you; what are these? People around you may be able to help you to identify what these are.

You might want to consider monitoring your fatigue by rating how tired you feel before and after different activities, perhaps on a scale of 1-10. This may give you an idea of which activities you find more or less fatiguing. It is important to recognise those activities or situations that are more tiring so that you can plan for them in your daily routine. Once you are aware of which activities are more or less tiring, then you can prioritise and set yourself realistic targets of what is achievable in a day.

How do I manage fatigue after brain injury?

For some people fatigue improves over time. However, for many people fatigue is a condition that they have to learn to manage in the long term.

There is no single cure for fatigue following brain injury, although recent research has found that cognitive behavioural therapy can help with managing fatigue by increasing a person's understanding of their experience of fatigue, triggers and ability to respond.

Managing fatigue requires a variety of strategies to address the factors that are contributing to it. Some of these strategies may seem like common sense and some you may already be applying. Taking the time to consistently put some of these principles into practice will hopefully allow you to cope better with everyday activities and feel more in control of your life.

Explore the links below and download our booklet Managing fatigue after brain injury (PDF).

My story

Fighting fatigue

Managing fatigue is not about taking it away but controlling it. With a little help from Headway’s Managing fatigue after brain injury booklet and her neuropsychologist, Sarah Tomlinson was so successful in controlling hers that she was able to sit her final university exam only two and half weeks after undergoing surgery to remove a brain tumour.

Read story