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Fatigue – just tiredness?

Fatigue is one of the most frequently reported effects following brain injury. Fatigue however is not just tiredness which we all experience from time to time. Fatigue can be totally debilitating. A level of exhaustion which impacts the ability to even function.

Headway, the brain injury association undertook a survey in 2019 called “Experiences of fatigue after brain injury.”

The survey results reported that:

  • 87 % of brain injury survivors feel that fatigue has a negative impact on their life.
  • 75% of brain injury survivors feel that people in their life do not understand their fatigue.

Fatigue is a real issue for many following brain injury.


The reasons why fatigue is experienced after brain injury has historically been poorly understood.

Fatigue can be as a direct result of damage to a structure of the brain. But can also be because of the extra effort and concentration it can take to complete a task that becomes more challenging after brain injury.

Most international research studies agree on the high prevalence of fatigue being reported following brain injury. But research has shown that there are many varied factors that make people with a neurological condition including brain injury, more susceptible to experiencing fatigue.

Types of fatigue

There are different types of fatigue. Although there are many different labels to describe the types of fatigue experienced. Generally, symptoms can be split into physical, psychological and mental/cognitive.

Physical fatigue– can present as a feeling of muscle weakness, being clumsier than usual, suffering an  increased frequency of  headaches, having difficulty sleeping/or experiencing sleep disorders, having digestive issues, suffering with impaired speech (slow or slurred). Physically, the body needs to work harder to do things that were easier before a brain injury.

Psychological fatigue – can manifest as feelings of depression and anxiety. It can present as difficulty controlling emotions being angry or apathetic and having negative thoughts. This type of fatigue can become more noticeable when under higher levels of stress.

Mental/ cognitive fatigue – comes from the extra effort it can take to concentrate and stay focussed. Sufferers can experience “brain fog”.

Effects of fatigue

Fatigue can intrude on both home and work life after brain injury. A person suffering with fatigue may withdraw socially, be more irritable/distracted and have more difficulty managing responsibilities. They may struggle with multitasking and seem to be less motivated or engaged.

Some common triggers to fatigue are in the workplace such as working at a computer for long periods, dealing with paperwork, being in a busy/overwhelming environment.

If fatigue isn’t managed, then it can result in total exhaustion which can take time to recover from.

How to manage fatigue ?

For some people fatigue improves gradually over time. But many following a brain injury must manage their fatigue over the longer term.

The consensus at present is that medication on its own is not the sole solution. Research does show a positive impact of CBT (Cognitive behavioural therapy) and reducing stress using techniques such as mindfulness.

Sadly, there is not a wonder cure for fatigue. There is still much to learn. But in the meantime, it is important to enable the person with a brain injury to understand their own experience of fatigue and importantly what helps them to manage symptoms.

Advice and support, based on others experience of fatigue and tips that may help to manage symptoms are as follows:

Know the triggers – Pay attention to the triggers to fatigue that you or those around you notice. Everyone is different.

Planning – following a schedule can be helpful. Planning things that require the most physical or mental effort earlier in the day. But be realistic in your planning and avoid putting too much into the schedule. Try to pace your activities with frequent breaks and build up activities gradually.

Exercise –  research has shown that people with a brain injury who exercise regularly have an improved mental function and alertness. Over time exercise and being more active helps to reduce fatigue and helps to build stamina.

Sleep hygiene – getting more sleep and rest is important. A regular sleep routine is important, getting up/going to bed at the same time each day. Avoid watching TV in bed and avoid using tablets or phones before bed. Have a calm environment and develop a routine before bed to help wind down and relax.

Stimulants – Alcohol – makes the symptoms of fatigue worse. Caffeine – avoiding later in the afternoons can help.

Avoid stress – avoid or reduce stress levels where possible.

Medication – get a GP to review any medication to check that is not playing a part in the feelings of fatigue.

Balanced diet – A balanced diet is important in managing fatigue; avoiding fatty, and sugar processed foods.


Further research is needed to understand this complex issue and help to manage the impact of fatigue following brain injury and other neurological conditions.

For those suffering with fatigue or supporting someone who is struggling with symptoms, there is some very useful information and support from organisations such as:

Headway, the brain injury association;

Brain & Spine Foundation;

The United Kingdon Acquired Injury Forum (UKABIF);

Brain Injury is Big .

Contact details:

For further information, or to speak to a member of the Head Injury Team, please email [email protected].

Nothing in this article constitutes legal advice. Please be aware that the relevant law may have changed since the date of publication of this article.

By Laura Merry, Partner

December 2023