Fatigue After Brain Injury: BrainLine Talks With Dr. Nathan Zasler

Nathan Zasler, MD, Interviewed by Victoria Tilney McDonough, BrainLine
Fatigue After Brain Injury: BrainLine Talks with Dr. Nathan Zasler

BrainLine sat down with Dr. Nathan Zasler to talk about the issues of fatigue after a traumatic brain injury. Dr. Zasler is an internationally respected neurorehabilitation physician who specializes in brain injury.

BrainLine: Describe fatigue. What exactly is traumatic brain injury-related fatigue?

Dr. Zasler: Think about a car. It needs gas to run. If your tank is low, your car will start sputtering and then stop once you have reached the end of your reserve. It’s the same way with fatigue after TBI. Fatigue is caused by a decrease in physiological reserve, which includes a person’s physical and mental reserves. When your brain is “tapped out,” you feel tired. Basically, when a person’s brain is overtaxed, fatigue will set in.

Although one formal definition of fatigue that has been proposed states that it is the failure to initiate or sustain attention or physical activity that requires self-motivation, there continues to be debate about how best to define "fatigue." In part, it’s difficult to define the term because fatigue is subjective — that is, it is solely based on patient report — and it is really more a symptom than a diagnosis. Just like it is difficult to tell if someone is in pain, it is also challenging to know if someone suffers from fatigue unless they tell you so. But generally, people with TBI have described fatigue as a sense of mental or physical tiredness, exhaustion, lack of energy, and/or low vitality. Unfortunately, we don’t have any definitive screening tools for fatigue, so there is no universal way to measure it.

Cognitive and physical fatigue can occur separately or together, but most people seem to have more problems with the mental side of fatigue after a brain injury. They say they are not as quick as they used to be, mental tasks that were once easy are much more difficult, and they tire far more easily even doing something that used to be simple like reading, studying, or working.

Although there are limited long-term studies, some research indicates that fatigue is usually short-lived after most mild TBIs. And in my experience as a physiatrist, fatigue in patients with mild TBI usually lasts no longer than three to six months. However, for some people with mild TBI, their fatigue is more persistent.

BrainLine: How common is fatigue after a brain injury?

Dr. Zasler: In the general population, fatigue is a common complaint with some studies citing an incidence of 10 percent. But for people with traumatic brain injury, it is one of the most common problems post-injury. Fatigue affects not only people with moderate to severe TBI, but also those with mild TBI. And we still need more research to better understand this issue.

BrainLine: What does fatigue look like after TBI?

Dr. Zasler: The spectrum of fatigue is as broad as the spectrum of traumatic brain injury, itself. Everyone’s brain injury is different and everyone’s symptoms will be different. There are also many variables when it comes to post-TBI fatigue — from levels of severity to pervasiveness. Some people may be very fatigued all the time and others may only be fatigued after mental or physical exertion.

Most people who have fatigue resulting from brain injury only experience the problem at certain times and not all the time. They have more energy in the morning and tend to be more tired later in the day. People’s levels of fatigue also depend on how much they are pushing themselves physically or cognitively, and whether they are making time to rest periodically during the day and pace themselves.

Depression, anxiety, or stress can also contribute to the degree of a person’s fatigue or, alternatively, may even be the cause of the fatigue. Not everyone with a TBI will experience fatigue due to their brain injury. So, each person’s levels of fatigue, if present, may change over time during their recovery, in terms of both cause and level of severity.

BrainLine: Why do these problems occur?

Dr. Zasler: Unfortunately, we don’t really know. There have not been a lot of conclusive studies conducted on fatigue after brain injury. Much of what we are discussing is experiential. Some have theorized that damage to the basal ganglia — which are structures deep in the brain — are the critical areas involved in the generation of fatigue. Others have noted that other areas of the brain may be involved as well.

BrainLine: What kind of information should people with brain injury give their doctor to help the doctor better understand their issues with fatigue?

Dr. Zasler: This is a two-way street, of course. People should give their doctor as much information as they can and, in turn, the doctor needs to ask the right questions and get as full a picture of the symptoms and situation as possible.

First of all, it’s important to establish the cause of fatigue; it may not be a result of the traumatic brain injury. It could be something else, and those other potential causes should first be ruled out. Other common contributing factors for fatigue can include:

  • lack of regular and restorative sleep
  • psychiatric issues like depression or anxiety
  • chronic pain
  • chronic stress

There are also less common causes for fatigue that should also be ruled out. They can include:

  • seizure-related fatigue
  • hydrocephalus
  • hormonal abnormalities, like hypothyroidism
  • nutritional deficiencies such as low B12, anemia, or blood cancers (i.e., leukemia)
  • renal failure
  • hepatitis

All of these causes, common and less common, should be considered and then ruled out as the sole or contributing cause of a person’s fatigue before considering TBI as the cause.

Once other causes of fatigue are ruled out and the fatigue is found to be neurogenic —related to the damage to the brain’s nerve cells — some of the topics and questions that need to be covered in the doctor’s evaluation include:

  • When did the symptoms of post-TBI fatigue start?
  • Did the onset of fatigue symptoms correlate with any other event such as starting a new medicine or getting depressed?
  • What helps make the fatigue go away, or decrease?
  • What aggravates it?
  • What triggers it?
  • In what ways are you fatigued physically, and when?
  • In what ways are you fatigued mentally, and when?
  • How is your sleep?
  • How is your mood?
  • Do you suffer from significant chronic pain?

The more information an individual or their family can provide, the more information a doctor has to make a precise diagnosis.

BrainLine: Can you explain why making sure you get a specific or accurate diagnosis is so important?

Dr. Zasler: With any medical issue, an incorrect diagnosis can set a person back in his recovery. It is important to make sure that you are seeing a clinician who is knowledgeable about traumatic brain injury. You can ask for references from other clinicians, from TBI organizations like your state’s Brain Injury Association, and from other patients. And you want a doctor with whom you feel secure, someone who is truly listening to you and asking questions.

Don’t be afraid to take your time in selecting a doctor. One thing that surprises me time and time again is that no one these days takes the initiative to interview potential doctors before making a selection. You can set up an appointment with a doctor you are considering to get a sense of his bedside manner, knowledge, and philosophy. When it comes to TBI, the patient/physician relationship may continue for many years, so choosing well is very important.

BrainLine: What can make fatigue worse?

Dr. Zasler: If you have neurogenic fatigue — that is, fatigue related to the damage in the brain’s nerve cells — here are some things that can make the fatigue worse:

  • not using pacing strategies appropriately, like dividing work into “chunks,” and not getting overly fatigued by working to long at a given task
  • not getting regular, restorative sleep
  • not taking the necessary naps or getting the rest you need throughout the day
  • not getting proper exercise or nutrition
  • taking medications that have sedative properties
  • having too much stress in your daily life

These suggestions are basic common-sense guidelines that clinicians should apply to help people with fatigue after brain injury. After all, the more a person learns about how and when his fatigue manifests itself, the more he can schedule his day around his levels of energy and create strategies to keep symptoms at bay.

BrainLine: Are there related problems that often occur with fatigue after TBI?

Dr. Zasler: The main ones are depression, anxiety, and stress. These often go hand-in-hand with post-TBI fatigue; one can exacerbate the other.

BrainLine: What advice or strategies do you offer your patients who are struggling with fatigue after a brain injury?

Dr. Zasler: Once I’m pretty sure that the fatigue is related to the TBI, I emphasize basic strategies like:

  • getting good regular, restorative sleep
  • making sure to get rest when you need it, not after you have become overly tired, stressed, depressed, or in pain
  • breaking activities into several steps through scheduling activities, “chunking” (that is grouping certain activities together) and pacing exercising
  • eating nutritious foods
  • asking for help when needed

BrainLine: What about medications for fatigue?

Dr. Zasler: Medications can sometimes be quite effective. There are different medications that range from more mild, pro-arousal agents like Provigil or Nuvigil to other non-stimulant agents like atomoxetine (Strattera). In the most resistant cases, traditional psychostimulants like methylphenidate or dextroamphetamine can also be considered. In general, drugs are not what should be tried first. They are something to consider for people who don’t seem to be improving with their TBI-related fatigue or when their fatigue is very functionally disabling. The potential for keeping people on long-term drug treatment is certainly present, although to my knowledge this has not been studied in persons with TBI and fatigue. We need more research in this area to determine which drugs might be effective, and for whom.

For a list of current research on fatigue, click here.

Posted on BrainLine February 4, 2010.


Dr. Zasler is an internationally respected physician specialist in brain injury care and rehabilitation. He is CEO and medical director of the Concussion Care Centre of Virginia, an outpatient neurorehabilitation practice, as well as Tree of Life, a living assistance and transitional neurorehabilitation program for persons with brain injury in Glen Allen, Virginia.

He is board certified in physical medicine and rehabilitation (PM&R) and fellowship trained in brain injury. Dr. Zasler is a clinical professor of PM&R at Virginia Commonwealth University in Richmond, Virginia, as well as a clinical associate professor of PM&R at the University of Virginia in Charlottesville, Virginia. He is a fellow of the American Academy of Disability Evaluating Physicians and a diplomate of the American Academy of Pain Management. His main areas of clinical and research interest include neuromedical issues in acquired brain injury (particularly mild TBI, neuropsychopharmacology, and low level neurologic states), differential diagnosis in acquired brain injury community-based care issues, and chronic pain rehabilitation, including headache.

Dr. Zasler is a practicing clinician who is involved with community-based neurorehabilitation and neuromedical assessment and management of persons with brain injury, neurodisabililty, and chronic pain. www.tree-of-life.com.

Comments (87)

Please remember, we are not able to give medical or legal advice. If you have medical concerns, please consult your doctor. All posted comments are the views and opinions of the poster only.

I am 24 years post severe TBI. I am now nearly 61 y/o. I am experiencing increasing brain fog, falls, and depression. I worked for the last 20 years part time but three months after my 20th year celebration, I was fired with a group of 6 others who also have disabilities.

Since December 3rd, 2020, my falls have increased, brain fog has increased and four months ago, I had a total hip replacement for a damaged hip that was injured when I also had the TBI.

The original injury recovery is a blank spot because I was in a coma for 7 weeks. This recent hip replacement has put me back 23 years concerning balance and weakness.

Can I hope to return to my prior level of functioning and losing the brain fog I thought I had conquered?

I have post-concussion syndrome. 2.5 years. The fatigue is crippling hitting me so hard I cannot open my eyes or get up. Many other pcs people I talk to experience the same. It irks me that the literature still assumes concussion and mtbi just get better, so many don't. The biggest misconception on tbi that exists in medicine is that a mild injury means a mild outcome or a severe tbi means a worse outcome. It's far from that simple. My friend had a severe tbi and he works and no one would know, I have a concussion no loc and I can't leave my house or barely take care of myself due to symptoms.

I suffered a concussion from a car accident on May 14th 2020 after being T-boned at over 80 mph i had severe wiplash aswell, that caused me to lose consiousness upon impact. Early symptoms where blurred and double vission(right eye only), neck and head pain and throbbing, ringing in ear (right ear only), drained mentally and physicaly, i had to eat constantly to keep any energy(right eye would get even blurrier if i didnt eat) 2 months later my energy came back i started exercising and weight training BIG MISTAKE after 3months from the concussion i got ibs and nerve and muscle pain I became anxious and depressed spine injury pinching nerves could be cause. I am improoving with rest, walking and enjoying nature. Still have arm and leg fatigue but it is improoving this is my second concussion within 10 years time.

Doc: After 3 mths since Dec 26, 2019, my wife admitted to hospital:
nausea, vomiting, loss of appetite, loss of 25 lbs continued. After 7 days patient discharged without solution. March 17, 2020 mass found in head through ct. Brain surgery on 3/22/20. Removal of benign meningioma (lg) that caused midline shift of brain to Rt. . Released 3/27. as of today 6/17/20 patient still very weak, fatigued. Why?

Please have your wife see a neuroendocrinologist from a pituitary center. I had those issues, and she could have damaged her pituitary. She could be adrenal insufficient, or have thyroid and growth hormone issues after her head trauma.

Hi all! This one is really a good post. It is going to help me a lot. The stuff and is very well topic related and useful for me. I quiet like the writers point of view. Good job.

I am 4 years post TBI and was diagnosed with hypersomnia... so don't really get restorative sleep, so I'm exhausted still constantly. Good times. I've been exercising. Im most awake in the morning. I try to eat healthy... I have a hell of a time losing weight. I've tried pretty much every stimulant and neurotropic med. I'm so tired of being tired.

thank you for posting this. This yeR I am 4 yrs this. I feel exactly the way you do. So glad I found this site. Explains alot!

May be a discussion pertaining to fMRI procedure could be beneficial. It is still considered “off label” type of test, But I want to know what the heck is causing my fatigue . And yes I have had two concussions, one significant , the other two years later was small but triggered PCS.

Recovering now for 11 months after being struck on the head with a dumpster lid. Still experiencing significant fatigue. neuro-psychologist, neuro-optometrist, occupational therapist etc. all attribute in part to eye strain from vision changes related to TBI. I work in front of a computer all day. Anyone else with this issue?

What kind of vision changes? I'm in front of a computer all day too.

10 yrs post TBI (car accident) and I still have issues with fatigue. I have found regular exercise, eating well and managing my tasks helps a great deal. The advice in the article are spot on for what helps me. I am lucky to have great / understanding support. I often wonder if this is a forever thing, it appears to be the case. But I manage and I know you can too :)

My son had a moderate TBI from a car accident 15 months ago and still suffers from chronic fatigue daily. He works in front of a computer all day too. I bought him blue light glasses which seem to help with eye strain. You could try that... and should wear them anyway as studies are now showing blue light also leads to early macular degeneration.

I have had two concussions in three years - both times I was rear-ended in accidents at 30-40 miles/hr speed. I have extreme fatigue, sometimes dizziness and burning sensation in my brain. It feels like a fresh wound on the outside of my skull. I am wondering if this happens to others too? No medication has helped me till date. I exercise or run when I have any energy; others times I cannot handle the pain/aching in the back of the head. I have tried physical therapy and acupuncture - both gave me some relief but now the pain is back full force. I have also have a bit of hearing loss. Pls help and advise. Thanks! Jyoti

I got hit by a car while running in 2013. It was pretty bad. Suffered a broken jaw, shattered scapula and still have traits of the concussion forgetfulness and fatigue most times. I found that head and neck massage helped with headaches. Good luck with everything.

Good info on Fatigue after a TBIly biggest struggle 2 years plus later. It is indescribable and debilitating although I am doing a d will continue to do everything to get better. My purpose is to inform people that don’t understand we don’t want pity we want understanding. People in my life want me to just get over it and trust me I want to but when you get reminded and hit hard everyday with issues starting when you wake in the moment feeling you been hit from a freight train and then continually getting exhausted after doing simple tasks continually during the day and get migraines I also suffer from PCS, PTSD, Chronic Pain, 50 percent Visual Field Cut, dull senses, depression, cognitive issues, personality changes, ADD, emotional issues, sleep disorders, just to bake same. it’s just impossible to do so far in my recovering. It does not mean I will stop fighting or finding the answers as I am a warrior and will never get up no matter how hard it is. My hope I will and if I do I will share them with those who are going through similar challenges. I want to inspire others to do the same and get though the challenges of difficult situations. God bless us all

Possibly Occipital Neuralgia

I have a brother, who was beaten up really bad and ended up with a concussion. This was about two yrs. ago. This same brother was told by a doctor that he had a stroke, which affected his frontal lobe! The doctor didn't know when it happened, just that it did. I remember my brother's girlfriend calling me, a while back, and telling me that my brother had passed out, and was going via ambulance to the hospital. My brother has had a drinking problem, for a while now, and I love him dearly, but we have drifted apart, although we use to be close. I called, his girlfriend, and she said he was ok after going to the hospital, so I never really followed up with what was going on. He is a grown man, and I have to be very careful because I have enabled him in the past and do not ever want to again. It is hard because I do love him. I am not sure but I think when he passed out, he had a stroke. I found out he had gotten some blood pressure pills from someone because he couldn't afford a doc. The pills were way too large a dose for him. His blood pressure dropped too low, and "wham" he had a stroke. He has not been the same since. He had finally quit drinking, and then started again, a couple weeks ago. This was after 8 months of being clean. He was also taking muscle relaxers because he suffers from severe back problems. My dad and I were so concerned, he had locked himself in a motel room, and was drinking, and taking pills, and we knew he could easily OD. So, we finally called, and had him picked up. He now hates us. And we don't know how long they will keep him. We hoped for awhile so he can get the help he needs. It is almost impossible with HIPPA laws to do anything to help mentally ill patients nowadays. My brother is an example of someone who needs help because he can not do things like keep appts, he gets angry easily, and he abuses drugs and alcohol given the chance. He is smart though, so he knows how to speak to docs, and nurses to make them believe he is ok! Between a rock, and a hard place.

I wrote all this because I wanted to ask — Can a post-stroke, and/or post-concussion get worst over the years, or from drinking, and doing prescription drugs abusively? He seems to be worse.

God help us.
Thank you for listening,

Great read. I am 45 now. I was shot in the head when i was 16. Can't expain the many things in my life that changed after that day in 1989. But i an still tired all the tine. It didn't go away for me. But I didn't let it stop me i became a chef and currently own my own restaurant.

Wow, congratulations! Which lobe was your injury? Someone close to me has left partial & right occipital injury recently apr 7th, he's slurring right now but has all the memory, just now barely moving right side of body it's been paralyzed since he woke up 2wks after gun shot. I'm guess he's got a long road to recover... breaks my heart

Wow, i was shot in the head, too. I never came across anybody else that suffered such an injury and "recovered" enough to continue a "normal" life. I thought I was alone...

Thanks for adding this comment. I was at my wits end after suffering with post concussive symptoms, mainly headaches and fatigue/low energy, pressure in head. And not able to think properly. After reading your post I have made an appointment with a chiropractor who does cranial adjustment and acupunture. We will see but I am hopeful this will work.

I am recovering from a motorcycle accident and suffered a TBI. At first I seemed to be recovering ok .. then down with pneumonia and since then the headaches and fatigue started and low energy. Everything you mentioned.


I had a critical TBI 1 year ago, 1 month coma, glasgow 5 and all the shit that comes with. I was barely able to read a book more than 5 min without sleeping. All these simple tasks like driving, shopping or having conversations where knocking me down.

I wanted so badly to have an answer to that question : " when the fuck that fatigue is gonna get out of me" ? no doctors could answer me because the human race doesn't know shit about TBI and that's the truth. We are alone today. But you know what ?  i think i've found the answer.

The cognitive fatigue we feel is linked to our cognitive weakness. See, all what we are doing all day is just too much for our damaged brain. So, why not doing cerebral workout to recover that brain ? that's the question i asked to myself and so i started to do intensive cerebral rehab (1 hour a day of cognitive stimulation exercises. i use medical approved games like happyneuron or dr kawashima).

In no more than 3 month, i started to see tremendous progress. I was able read for hours again and do so much things compared to before ! even stay a full day without sleeping ! and it's not over, i'm still going to bed early in the night but my days are so full now !

My other keys to recover that fatigue are intense workout (really helps mood, getting relaxed and brain recovery in general), intermittent fasting, mindfulness meditation and omega 3 (epa/dha supplementation). i can't explain why but its all linked with the "neurotrophic factor". we wan't to increased this because it's so good for us. 

Excuse myself if my words are a bit weird, i'm not english born. But try to do this people and do not give up ! you'll not be disappointed with the results ! I love you all and wish you a great recovery ! much love my TBI'S

Thank you for this info. As a person who has suffered with depression and fought tiredness my whole life it’s unfortunate that I now have a new reason to be tired. I was diagnosed with PCS a few days ago and refuse to give in to it. I’ve worked so hard my whole life to try to live a normal life and I will do anything to to improve my exhaustion. I appreciate your advice.

Hello so great to see that you overcame your fatigue, that’s so great to see! I’m going to try the methods you use for sure. I just have one question. What is the kawshaima? I can’t find anything to do with it.

Thanks for the tips, I'll give it a try and hope it works. My heart skipped when a doctor mentioned it could take three or six month to rid fatigue. I have been a month at home after recovery from a severe head injury and wondering when the fatigue I have been experiencing will dissappear. It's been getting me worried awhile now since I feel l'm no longer at my optimum.
I will find the mental exercises and even meditation if it will help. God helping. Thanks for sharing and support guys. And I wish us all good recovery

It’s been 2 yrs since my head injury my surgeon stated I hit my head perfectly in the wrong spot I spent 5 months recovering in the hospital which included me having a shunt installed in my brain to help me with my newly hydrocephalus development my wife of 28 yrs left me after I was released from the hospital not great timing my stress level is high because of that I’m very lonely I’m constantly fatigued I’m hoping in time the fatigue will improve if anyone has any comments that may help me it would greatly be apreaciated ps I’m 65 yrs young or used to be now I would classify me as 65yrs old thx

I will try this

My husband suffered a traumatic brain injury in a motorcycle accident. It's been over 10 years and everything is almost 100 percent but he has somewhat low energy. At first for 3 months after the injury he could sleep only 15 minutes at a time. He was utterly exhausted and said it felt like torture. I took him to a acupuncturist and she got him to sleeping 4 hours at a time, then 6 hours but said she could do.no more. She suggested taking him to have cranial adjustment.Our MD actually had a cranial massage therapist that worked out of his office. He slept 16 hours solid after the first cranial adjustment. The cranial adjustment took pressure off his brain. Your scalp does move after a accident sometimes. He went 4 more times for cranial massages and adjustment. He got on a regular sleep schedule but does still tire easier than he used to. Don't know where we'd be without the acupuncture and cranial massages.

10 months on now from brain haemorrhage due to car crash. Initially I felt I wanted to keep a duvet wrapped around my head to help the pressure/pain (neither one nor the other but feeling of both is the only way I can describe it). Chronic mental and physical fatigue although have been mentally pushed due to running own company and moving house twice since! Experiencing mental fog, disorientation, confusion and very short term memory loss daily. Have explored depression incl walking depression but feel this is not the cause. Fall to sleep easily but wake regularly at 2-3 am for 2-5 hours. More tired in morning than in evening. cigarettes seem to help me focus. Dehydrated often. Find it difficult to concentrate on conversation especially when my children are describing something. Will try yoga meditation to relax to see if it helps as feeling hyper brain activity throughout the day. I hope this helps with research. This is a very real issue and definitely post injury. fatigue post tbi MUST be better researched and recognized. Tomazipan helped, anti-depression drugs didn't in fact made symptoms worse, will try marjuana as I know this helps with MS greatly. Very annoying that experts sit on the fence on post traumatic brain injury symptoms! Rebecca

CBD knocks me out cold. I wonder if it will help you with sleep. It does reduce some pain, but then I have to sleep, so its not that great for me.

My son suffered a TBI and cerebellar stroke almost 2 years ago. He still has pretty intense fatigue all the time, even after sleeping 12 hours. We have had every test including a sleep study but all are normal.

I suffered a TBI, which severally affected my cerebellum. After countless tests and misdiagnoses, I, personally, believe it has something to do with my muscle spasticity. The cerebellum controls involuntary muscle movements and functioning. I feel like my muscles are contracting and releasing 24/7. This is why i am getting an EMG test conducted by a dr of physical medicine and rehabilitation. This test will help pinpoint where the disruption is occurring. Im told that my tbi may be the catalyst of the fatigue, but may not exclusively be the cause.

Joe, I got a TBI in 2017 also. Yes, fatigue is also a huge problem for me. One thing that has been very helpful is Functional Neurology. There is a center in Minnetonka, MN and they do an intensive week there, it is called the Functional Neurology Center. I did the week a six months ago, and will return soon for some follow up.

Nathan D. Zasler, MD, Nathan Zasler, MD is CEO and medical director for Concussion Care Centre of Virginia, Ltd. as well as CEO and medical director for Tree of Life Services, Inc.  He is board certified in physical medicine and rehabilitation and fellowship trained in brain injury. He sounds like a well educated and informed individual, but like most of my doctors everything sounds like guessing and taking both sides.  Nobody has strong advise its all about structuring the billing. 

Sept. 2005 - drunk driver hit me.

Dec. 2005 - neurosurgeon diagnosed me with Post Concussion Syndrome.

May 2010 - another motor vehicle accident - rollover - fatigue, dizziness and headaches exponentially worse.

Is there an end to the fatigue, dizziness and headaches?

I've had TBI since 2012 and I could never figure out why I was so tired all the time, until now, including my insomnia problem. I'll stay up for 3 to 4 days at a time, no matter how many sleeping pills I take or prescribed medication. My insomnia usually kicks in at least twice a month and it's the worst thing in the world. I just started taking adderall, because I was diagnosed with ADHD after my accident, but I never took it because I was scared and now I'm wondering why waited so long. It really is a miracle drug if you actually have ADHD, but when it wears off, you crash and you crash hard. But at least it helps get me through the day, it also puts me in a better mood and I actually sleep better taking it. Now, as far as my temper, I snap so much more easier than before and it's really bad, like I have no patience and I cannot handle anything. I hate the fact I'll never be the same, but Alecia study more and find me more options I've never heard anything about. This yoga hoping, maybe I'll try that. I mean, I'm so so tired that I haven't cleaned my house in 3 years. Yes, I get the trash out and nasty stuff out, but it's still really messy and I'm so ashamed. I hope the future brings more reason to this because I can't stand being so tired and yet at times I'm up for days, people even ask me if I'm on something and it hurts. I was once pulled over and the cop made me do every sobriety test known to man and that was so embarrassing :( I wished people understood how bad it really is, and my memory is going, but before that, I started having seizures. Not to mention I am very very sensitive to noise and light. I finally went to a neurologist after five minutes he told me he didn't have time for this and I was billed $500 bucks for 5 minutes only for him to say, he didn't have time.

Mindful based stress reduction helps tremendously. Any type of meditation is beneficial. I currently practice TM. 

Dom - I would like to hear more about your results. 


There is some research behind mindfulness based stress reduction being very helpful. Somebody below mentioned yoga- that is similar enough I think to work too. My OT recommended yoga actually.

good luck everyone

update 2016, after Tbi check growth hormone level-blood only 3x during 90 minutes, Gh is responsible for quality of life try than combination of peptides ghrp6-2 plus sermorelin than cycle with mk-677 you don't need gh for 1000s£ do it with private consultation cheers Dom

I had history of seizures and found that scar tissue was the cause and qualified for brain surgery on the focus.after being over 2yrs now,there are days I feel tired but once I get around I'm ok til I get bored and sitting down for quite sometime.to me it just seems like certain weather makes me tired more quiet moody on cloudy days.if nice sunny I feel good like a new person that could do anything like my memory focus and concentration is all there.plus I can drink all the caffeine I want and still get tired.ugh...

Hi I suffered a traumatic brain injury in October of 2003.... I was in a coma for 28 days at our medical center. I was an active 17 year old I played sports and that's basically what my life revolved around. I made a quick recovery and went back to playing softball ASAP. I assume this is why I never had much problems with fatigue until now? I agree that smoking marijuana did help with a lot of the symptoms now that I don't smoke. :) I was young and why not right? Well it is illegal here in Oklahoma so of course I quit once I got older? At the moment there is a fight for medicinal and I know several people who have suffered a brain injury and would benefit but the last.... 3 years or longer I have been struggling with the fatigue and when you get fatigued your emotions go rapid I have learned... also your temper? I never had much of one before I was easy going and just let things roll off but some days actually most I wake up just feeling most irritable. Its frustrating and that's why I've started looking online. I have had such a hard time getting in to a neurologist or finding someone who would even send me? I've been fighting for disability since 2008 and... I am lost at what to do about the fatigue. My psych. Currently has me on 40mg vyvanse and it does help but I still just... it feels and I know it appears like I have no motivation and I am lazy but lol I literally am sitting here thinking about all the things I need to do and want to do but I just have no energym I've done a sleep study tech. Two.. .. the first I did not sleep but ten minutes an that was the ten minutes before they wake you. The second I slept with the help of a lot of sleeping meds. They found I did not go into a true sleep the full 8 hours I slept. Also.... I seem to wake up feeling more energized and just better all around if I only sleep 3-4 hours compared to say the full 8 hours. If I sleep a full night I'm even more tired. I wake up tired and when I go to go to sleep it's like a switch switches and I am wide awake. I have seen a neurologist once and he informed me I have extensive damage that appears to have been caused from not having proper treatment all these years but that he cannot treat me without a psych eval and my insurance does not cover it. I'm currently waiting to get in with one at Ou medical but that will take months and months so I began looking for answers. I can't get help from anyone else so I've learned to do it myself. But I think I will have to try some of the things people have suggested in comments here. With the approval from my psych of course: ) but I have found that when I don't rest well my post traumatic headaches are worse and not much helps except naproxen sodium. The tylenol or excedrin seem to cause rebound migraines so I'm wondering is this common? The headaches and fatigue together?

In 2013 I fell about 15 feet and head first into the concrete, just my actually head hit the floor my body was up against the house, so all my weight and force went to my head. As soon as I hit the floor I jumped up, I noticed my face and almost my entire head was completely numb. That actually freaked me out way more because I knew I should of been in excruciating pain yet I didn't feel a thing . My cousin convinced me to go to the hospital and about 30 min after impact I was beginning to feel the pain kick in. The Dr was completely shocked when he learned I didn't lose consciousness, got up off the ground on my own and he told me I could have died, and said "as a matter of fact you still can" It turns out I broke two eye sockets,nose,upper and lower jaw. He said I broke every soft bone in my face and I needed surgery ASAP. I ended up getting 35 screws and several metal plates put into my face but they cut me open above my upper gums inside my mouth and installed the metal (thus making it so I didn't have scars on my face) Let me tell you something, forget the fall! I never been in more pain in my whole life after that surgery, it hurt way more than the actual fall itself. I recovered fairly quickly, but honestly I swear the swelling didn't go fully down for at least 6 months. It took me about 9 months to get most of the sensation back in my face. To this day if I run my finger down my nose I feel electrical shock like sensations, as well as certain spots with no feeling (only on the inside of my mouth, the skin surface has sensation. It feels like I'm walking around with a fat lip all the time and it's horrible, but nothing compared to the journey that followed. Fast forward almost 3 years and I'm battling anxiety (mind you they did a great job fixing me up and the anxiety is not due to personal image etc, I look great, I look the same surprisingly) but about less than a year after surgery for no reason I just got smacked with constant fatigue. Waking up for me in the morning is horrible I feel groggy, bad temper, miserable, drained and almost like a mental ache. I know "mental ache" doesn't sound like a legitimate thing but that's the only way I can describe it. Psychiatrists don't seem to listen I'm on my third one already and they all just try pawning off SSRI or other variants of antidepressants, which don't do anything at all and make it worse. I decided to take matters into my own hands and life has been so much better. (Before you judge me I want you to know I tried my best to go about this the legal way, you just don't know what it's like to just have to deal with this with no break, I would have panic attacks and my BP would be 175/100. My Drs didn't want to give me Xanax (which I talked them into when I explained i know it's not a permanent solution or something that can be long term) so she also wrote me a script for vyvanse an amphetamine based medicine. (50mg) I tried asking for provigil but she told me I needed to do a sleep study, and she didn't have a problem with the vyvanse because she was also justifying it saying I might have ADD. The anxiety continued to a point and that's when I saw a post online about suboxone and how it's used off label by some knowledgable Drs for things like treatment resistant depression and anxiety, they make them in 8mg strips that go under your tongue, but one strip I would cut up and make it last 2 weeks. I wake up I have the peice ready, I put it under my tongue and lay back down and go back to bed. After about 1 hour my second alarm will wake me up for work and by this time I feel 1000% normal, no grogginess,anxiety,temper brain fog or anxiety. Most of the time I don't even need to be woken up by my second alarm and wake up alert on my own when the suboxone kicks in. I then wait to take my 50mg vyvanse because my goal isn't to get "high" I just want to function and be able to enjoy my life again, by around 11am-12pm I'll take the 50mg vyvanse and it gets me through the day and I notice it wear off by 5pm but will still do its job the rest of the afternoon. After adding low dose of suboxone 1/14th of an 8mg suboxone strip (extremely low dose in my opinion) I'm now able to do things like go to the gym, meet new people, work, keep my house clean AND enjoy doing it at the same time. I can now read something the first time and remember it, I don't have to go back because I didn't remember what I just read. I'm not forgetting things in the house and making 2 different trips back into the house for things like keys or wallet. If there are any Drs here reading this, PLEASE, look into the possible use of LOW dose suboxone (1/14th of a 8mg strip for me personally) it's given me my life back, it bothers me to know that there's this medicine and it changed my life, maybe even saved it, yet I have to resort to such means as buying 2 strips a month off the street. It helped with TBI related anxiety,depression and more. Also I just want to note that I never once abused opiates in my life, and I never was prescribed opiates for more than a month at one time (for surgery) And as far as "tolerance" I been using the same dose of suboxone for over two years and it works just as good as the first day! Me personally, I'd rather quit low dose suboxone than have to take tons of high doses of Xanax (which for me tolerance grows way too rapidly for it to be a plausible treatment) this is my situation and why I have to obtain it illegitimately, however my script for vyvanse 50mg is legit and authorized by my psychiatrist. I apologize for the atrocities of my grammar, I just wanted to make my post and was in a rush. Any questions or feedback feel free to reach out to me

I currently have a tbi from a cart accident 6 weeks ago, my 13 yo son had a horrific tbi 1 year ago, my husband had one about 7 yeasts ago, and my other son, adopted, came to us at 3.5, now also 13, with what we now know was a concussion, fell back off his chair in the orphanage just before coming to us, 7-8 stitches in the back of his head at 3 yo. We have seen debilitating fatigue, my kids can't do much of anything on the weekends, or they can't get up for school during the week. My son last year only had enough energy in his brain to keep him awake for 3 hours a day, enough time to eat, use the bathroom, ands play with the dogs - that was for 6 weeks until we got him on a vitamin regime. Calcium floods into the cells during tbi, too much of it, and throws off physiologic and metabolic processes. My son had his first full day awake after starting his vitamin regime, and this same vitamin is helping the rest of us. Magnesium, needed for over 300 chemical process in the body. Most people are deficient regardless. Blood tests don't show it because only 1% of it is found in the blood, the rest is within the cells. Coq10, diminishes with age and provides the cells with energy B complex helps the nervous system Fish oil, particularly dha which is for the brain, epa is for the heat Not too much calcium, until things settle, calcium needs magnesium, if not enough magnesium calcium will calcite in brain and arteries and joints. My husband's lost his sense of smell but it comes back every once in awhile, he slept ALL the time to the point we almost went bankrupt. one MUST be mindful of triggers, and lifestyle NEEDS to change.

I fell 20 feet off of a telephone pole in 87. I don't believe I passed out, I remember my helmet spinning away from me on the ground. I had a crushed L-1 with two rods placed in my back. Two weeks later I recall laying in my hospital bed and a flood of memories from the incident was rushing through my mind including preoperative care that I had received. When I got out of the military I would always have these neck pains and headaches, fatigue, slurred speech after too much mental engagements. I couldn't get through the Veterans Administration (VA) Rehab Education program and have even more problems with analyzing and focusing today with increased agitation as I'm getting older. I went to the VA for analysis and was told that I would have had to been knocked out to have a TBI and number two I would have improved over time. The fatigue has always been a constant with me since the incident.

In 2001 I sustained a TBI from a car accident. The doctors say my brain sheared at the brain stem.  I was in a coma for two weeks not expected to live. After I came out I was paralyzed on my right side, unable to talk, walk, swallow or care for myself. I was unable to open my right eyelid for several months as well. To the best of my remembrance of my ordeal, when my eyelid opened, my eye was paralyzed, so I had to wear a eye patch for several years until the Lord healed my eye enough for me to be able to not wear my patch. If I hold my head right I don't have double vision all the time. I can do most things now in a very limited fashion; ie; slurred speech, poor balance, poor eye hand coordination, memory loss, confusion, etc.  I am fatigued all the time, so I can relate to the stories on this site. It was a relief to hear some of the reasons. My limbs have felt heavy since I began to remember after my accident. I am able to do what I have to do, but it is only by pushing myself most of the time. I am no longer paralyzed, but numb as if I had a stroke on my right side. my muscles don't go into spasms nearly as often. It is by the Grace of God that I am here. Life is improving slowly. I asked my brother-in-law who is a registered nurse,if people recovered from brain injuries. He said, after the first 6 months recover slows & then they adapt to their disability.Here's to adapting!


Adrenal fatigue and/or an auto-immune condition can also come from the stress of TBI/PTSD.

Professionals need to recognise the problem of fatigue post stroke it's debilitating and I feel disabled by it !

Traumatic Brain Injury Fitness Cannabis, 5 words you would think should never go together, please think again.  I will say it again. Traumatic Brain Injury Fitness and Cannabis: What You Need to Know.  paying attention yet?

It might seem that cannabis and fitness wouldn’t make a great match, considering most people don’t associate physical activity with marijuana. But weightlifting and cannabis might be an exception. Cannabis users and fitness enthusiasts often have similar goals: to be in control of your body, a search for bliss and deeper awareness.

"Living life with a TBI while being the best father I can. Compare it to taking a journey of 101,009 steps but counting only every 10th step while wearing ski boots, in the sand, in the summer, without having any step count leftover.    All that while living it sped up to 3/4 time"...