Fatigue After Brain Injury: Getting Tired of Being So Tired

Question: 

My 28-year-old son was seriously injured in a car accident two years ago and suffered a critical brain injury. He can't walk and is still unable to straighten his legs. What seems to bother him more than anything is how utterly exhausted he is all the time. He was always such an energetic young man and finds the exhaustion terribly frustrating because it prevents him from working as hard as he would like to in physical therapy. How long will the extreme bouts of exhaustion last?

Answer: 

Fatigue is a common problem after brain injury. Estimates of the incidence of fatigue for individuals with TBI range from 50-80 percent. Depression, pain, sleep disturbance, and neuroendocrine abnormalities all have been associated with fatigue after TBI.

You should talk to your son’s physician about this problem so a careful evaluation can be done. Many of the medications that are used to treat spasticity, seizures, and mood can cause fatigue or sleepiness. Sleep disorders are seen in about 30 percent of people TBI even years after injury. In some cases, an overnight sleep study allows you to get a proper diagnosis and decide on treatment. Endocrine problems are becoming increasing recognized as a cause of fatigue. Low thyroid, low adrenalin, low testosterone, and low growth hormone can all contribute to fatigue. There is a lot of current research being conducted on low growth hormone and how to best assess and treat this increasingly recognized problem.

In some people with TBI — if no cause of fatigue can be found — their doctors often consider stimulants. Common stimulants used include amantadine, methylphenidate (Ritalin), detroamphetamine/ amphetamine (Adderall), modafinil (Provigil), and armodafinil (Nuvigil). Make sure you take your son to a doctor who has experience treating people with brain injury and with using these medications.

 

Posted on BrainLine June 9, 2011

Brian Greenwald

Dr. Brian Greenwald is medical director of Center for Head Injuries and the associate medical director of JFK Johnson Rehabilitation Institute. He is a clinical associate professor in the Department of Physical Medicine and Rehabilitation at UMDNJ-Robert Wood Johnson Medical School.

Comments

I had a 6 cm brain tumor removed in September 2015 and been exhausted ever since. My neurosurgeon doesn't want to know saying only counseling will help and my GP is simply out of her depth. I've done a lot of research on this and what's helping me this last week is acetylcysteine. It's not a drug but a supplement and works by aiding the production of glutathione which counteracts over production of glutamate (which is often seen in patients with cognitive fatigue). You can buy glutathione supplements but they don't pass the blood/brain barrier very well. I've just ordered some msm as that stimulates glutathione production as well

I am 28 years old now, going on 29 come this November. I had my stroke on the operating table during a surgery to remove a brain tumor when I was 26. The blood flow to my hippocampus was temporarily cut off, which is how/why my stroke occurred. The fatigue is only somewhat manageable with coffee and sleep, but I really hope there is an answer to curing my fatigue that I haven't yet stumbled upon. I still can't work as I'm constantly exhausted, and I find that my life is rather limited due to my fatigue. People suggest going to the gym like I used to before my stroke/surgeries, but I just don't have the energy to do it! I barely have the energy to get out of bed most days! I used to go to the gym 7 days a week and could max out the machines doing certain exercises, but now I can barely curl a 15 lbs dumb bell and just want to sleep! Please tell me the fatigue goes away! I just want a "normal" life again! (Never was all that normal to begin with!) I feel bad, because my Mom sees me every day as I cannot move out because I can't work; don't get me wrong, I love my Mom, I just wish I could be normal again for her! It makes me sad because I feel like she and many others look at me, and remember who I was before the stroke, so full of energy, ambition, drive; and now I am this... I really hope I'm not stuck this way!

Thank you all so much!!!!! I actually acquired an ABI which is just like a TBI and I am so tired all the time just like all of you are. Did any of you attend CNS??? (Center for Neuro Skills) ! did since May 11...although I'm outpatient now. I couldn't talk for like a month or 2 after my accident. And thank god they helped me. Sorry a lil off the subject....but I go to the doctor next Wed and thank you all so damn much for commenting about this....maybe I will finally get some help, thank God

Another element in my post-TBI exhaustion: my brainwaves had been knocked out of sync, so they were stuck in high-beta (aka. high attention) mode, which is exhausting. I did neurofeedback to increase my low beta (mellow attention) activity.

My 31 year old daughter (at the time) suffered a TBI  12 years ago, was in a coma for a month, semi-conscious for another two months, and finally, after three months became communicative.  Fortunately, she has since recovered much of her cognitive and physical abilities, but her fatigue in the beginning was constant.  We tried everything and anything to keep her awake so she could participate in her rehabilitation exercises.  Gradually, over time, her fatigue became less.  She still needs to take a morning and afternoon nap most of the time, however, and goes to bed earlier than most people in the evening.  But we have discovered her fatigue is not  physical beyond what anyone else might experience.  It is mental.  If she spends much time in a noisy or confusing atmosphere, she tires easily and needs to find a quiet place to rest for a short while to recover.  Her brain simply can no longer block out the extraneous noise of, say, a noisy restaurant or other such loud confusing place.  She enjoys playing in a community band, for instance, but trying to block out all the other instruments so she can concentrate on her own playing is tiring.  She puts up with it, though, because she loves playing with the group.  And that's pretty much the answer to the question about fatigue after suffering a TBI.  As many other people have commented before me, the tiredness does not go away.  It's better some days and worse on others.  In order to make the most of all your days, you learn WHAT makes you tired specifically, then find ways to cope with it.

I got run over by a vehicle in 2007. I got thrown 40 feet and suffered several injuries. I suffered a severe concussion the second of my adult life. I have lost all my energy and it is everything to just get out of bed. I don't remember the first 15 or so days after the accident. I'm not sure what to do. I'm tired of being tired. Any suggestions?

My husband suffered a TBI after a pool filter exploded, he was in a coma for 2 weeks, treated very poorly due to hospital SOP for treating "head injuries".

Every brain injury is different as are the deficits which come from the brain injury, My husband has seen many a DR. & my advice to all TBI's & caregivers is please go see a Functional Neurologist, they treat brain injuries in ways that will make you go OMG who knew & will leave you thinking about outside the box therapies...

My husbands TBI is going on 5 years & I know we still have challenges ahead. Remember EVERY Brain Injury is different, this includes ALL deficits. 

In May it will be 2 years since I fainted in a hotel bathroom and ended up on the top of a tile tub, fracturing my temporal bone, tearing the lining of my brain, blowing out my ear and (if that wasn't enough) having 17 staples in the back of my head because the force of the fall picked me up and threw me into the leg of the sink. I'm a runner and only find relief from my "bobble head" feeling when I sleep or run. But the last 6 weeks has been difficult for me. I'm tired all the time, my head feels worse and I've lost most drive to get excited about anything. Nothing feels better than sitting if I'm not running. I can't seem to get started on tasks that I once loved doing and when I do start them I have to talk myself into sticking with them. I've always been a go getter but doing nothing fits me just fine. I don't even enjoy socializing and if I do I want to sit or lean. Will this ever go away?

I suffered a TBI last September 2015 in a car accident that was not my fault. I was stationary and was hit hit by a car that was driven by a guy who was Drunk and on drugs, who had been out of jail for 1 month. He left me there. I was knocked out straight away, I was cut out of my car and had surgery that night to relieve pressure from my brain. I am still dealing with getting around the ins and outs of Cognitive Fatigue.... Reading the comments of this page has made me realise i am not alone and I understood what I am going through by reading all your comments... sometimes I feel like I am being to hard on myself and I over-do it a lot, and i dont rest enough... and then ultimately crash and burn. So thankyou for all this very useful information. 

Wow i'm so happy I found this. I was in a major accident, coma for a month and didn't really do any rehab after. For the last 5 years i've been feeling so alone. I have pushed myself harder then ever but seem to get fired from jobs for not concentrating, remembering things and making constant mistakes. I've been blaming myself for being stupid, not caring enough about the positions, ect. My gym recovery times were 10x the normal persons, I thought I was just being weak in the head. I wasn't like this before and thought I was making this up, using my car accident as an excuse and somehow convinced myself. I've been one hell of a mess. I hope this gets better. Life has been so depressing but i've been eating well (paleo style) and physically toned up (got a 6 pack) from trying to fix this issue. I can definitely say exercise and diet does improve the situation, but i'll probably take it more easy in the gym and put less stress/strain on my already overworked body

I suffered a TBI 4 years ago. Exhaustion was definitely a problem for me, as well as short term memory issues, difficulty concentrating, and I had a terrible time with noise (any loud noises, and background noise).  The last 5 months, I have been taking a brain supplement from Princeton University, and my energy is back up, and my memory and concentration issues are significantly better.  I am so glad I finally am improving!

Adrienne P

I am still recovering from TBI after an Armed Robbery on 4th April 2003. I have just finished an Open University French beginners course, everything is done in small bites. The main problem is fatigue all the time. Music is excellent therapy, I sing, not too badly so they say and I have also learnt to play the piano, I love it and all the doctors said I was finished. Not yet!

Fatigue after TBI for me is related to my adrenals getting fatigued. Finding a doc who believes in adrenal fatigue was my challenge. You can google James L. Wilson, he has a great book on it that's been helpful to me. I take Adreno-mend by Douglas Labs. Periodically with too much stress I have to spend more relaxing time in nature to heal. Wishing you the best!'

Hi my names Maddie and I'm 19 and attend the University Of Kentucky. I was in a fatal car accident during my senior year of highschool and hit a tree. I was in a coma 2 weeks. It's almost been 2 years since my accident and I was attending bellarmine last fall and was taking Ritalin and amantadine. Then second semester I lived away from home for the first time and was taking classes at the community college and dorming at UK. I started taking aderol because didn't like the way Ritalin made me feel. At the moment I feel like my recovery is going down hill, I am as tired as I have been in awhile. Last summer I had more energy than I do now. Last summer I also was in a fog and not 100% mentally there. This summer I'm mentally there but I am exhausted. I think I need to switch medicines. Any advice?

My name is Jose & struggle from the same thing, I've gotten a bunch of checks done & found that I have low testorone & low thyroid. I'm taking thyroid medication it has helped but my doctor won't prescribe me steroids.

Stress, talking & understanding and paperwork make me more tired than anything else. I need simple clear systems and NO complexity like contracts (which scare me) for cell phone, insurence, flat rentals and so on. I haven't got a smart phone because no idea how to use one or which to get. Used PCs for years before injury but now totally left behind with them and all technology, music and everything. I feel so left out. Is there much tech out there for us with milder brain injury? If so how can we access it (if no money) and be taught to use it? People with more obvious mobility problems sometimes (certainly not always sadly) appear to get far more recognition and help than us, it feels very unfair.

I had a TBI in 1999 and as stated in several of these comments ... the fatigue only gets worse (Sorry) But ... on a lighter note ... I have taken 2 medications for fatigue called Provigil and Nuvigil and they BOTH helped alot.  I do not take them everyday because I do not want my mind and/or body to become dependent on them. Hang in there ... I know ... that's easier said than done but a good outlook is better than a bad one. You can only do so much.  The fact that you're on here proves that you WANT to get better ... and some things do.  YOU are your best advocate ... READ READ READ and then ... READ SOME MORE. Keep trying different "things" to help improve your day to day life. Every now and then you will stumble upon something really good! For example ... some of my other deficits are SHORT term memory ... staying on task ... focusing ... not getting 5 projects going at one time and not finishing any of them ... and then sitting down and crying because I feel so ... stupid ... or so retarded.  Like going into the bathroom and thinking ... "What did I come in here for?" ... And then when I get ready to pee my pants ... I remember ... "Oh yeah, THAT'S why I came in here."  {{HeHe}}  Humor too ... is oh so VERY important.  Give yourself permission to laugh at yourself ... it sure is better than crying.  I DO THIS TO STAY ON THE CURRENT TASK/FOCUSED. Around the house I always wear a large safety pin on the front of my t-shirt.  If I am working on something that I really want to STAY focused on ...even something very SIMPLE ... I take a little piece of paper about the size of a 2" x 2" post it note and WRITE ON IT  ... for example ... LOOK UPSTAIRS FOR THE HAMMER ... so that if you get upstairs and wonder "Why did I come up here?" --->OR<--- something else upstairs gets your attention and you forget all about the hammer ... you can just look at your note and it will BRING YOU BACK to what you want to be doing.  This has helped me SOOOOOOO very from becoming upset from CONSTANTLY getting off focus and going ALL the way back downstairs to my project and realizing ... "Damn it ... now I know why I went upstairs."  Sound familiar??  Hang in there ... you are NOT ALONE.  I know at times it feels like it but ... YOU'RE NOT!!!

When I was 22 years old I had a car wreck one evening when driving home from college. I somehow lost control of the vehicle and ended up landing in a pasture. After landing in the pasture my vehicle rolled at least nine times, and out of the window I was ejected. I was then taken to the ICU at the local hospital for about a month before I went to Charlotte, NC. In total my stay at the hospitals was for nearly 4 months. I was in a coma for approximately 2 months. My TBI was so severe I was classified as being 3 on the Glascow Coma scale.

The real reason I am writing is to share how great a medication Adderall is. It helped me with my debilitating fatigue as well as helping my conscentration. So if anyone reads this who is experiencing major fatigue from a head injury mention to your doctor about Adderall. It was the game changer that has totally improved my life.

Hi I am 1 of the survivors of TBI and was in a coma for 2wks. It's a long road to recovery, I seen all the therapists I needed to see. Physio, occupational, speech, nuerocycologist, ENT, nurosurgeon and finally I'm training at the gym with a biokinetist. 8yrs have past, I'm still trying very much to get strong physically, and with keeping fit n getting stronger, this helps not to be as tired anymore. I feel that after a TBI experience, u will always be experiencing being tired, it's all about how u control and are able to adjust to ur new life. But the correct diet is also a big +. Hope I was of some help.

I'm a survivor of tbi, which happened nearly 7 years ago, and since then I've had to learn to walk talk and eat again.  In all this time I've never received help from doctors, they tend to shrug me off, but ever since my coma I've been fatigued so much that its stopped my normal life and being soo exhausted has got to the point where I've gained weight i now weigh twice as much as i used to, and fear I'm only going to get bigger as i age.  NO DOCTORS ARE WILLING TO HELP. Its basically a joke!!

I had a massive stroke in 2007. I seem to get fatigued easily and no one has done anything to help me.. Sleepy and ignored..
Hello. I also suffered a TBI coming up on 7 years ago. My doctor and neurologist don't seem to pay much attention to me when I tell them of my constant exhaustion. I pretty much live on energy drinks. I'm resigned to the fact that this is permanent, though I'm still getting on with what I can
I agree with the comment made on Jun 20th, 2012. Having suffered a TBI as a child (22 years ago), I have over the years developed 'coping mechanisms' to deal with the fatigue. However I have noticed in the past couple of years that the fatigue is as bad as ever, if not worse. While I know that for each case the extremity of fatigue is different and I have learnt not to talk about it but instead find ways to cope/ hide it. All the best to your son with his recovery
FYI--the fatigie after brain injury will never abate, diminish, or get better!! I had a tbi 15 years ago--today my fatigue is worse than it ever has been! You must find your own personal way to cope, so the prolonged and endless exhaustion is no longer a consideration. I choose to push through, and ignore it, when possible.
Energy Medicine is something that is now being explored more and more in the brain injury field as well as other areas of health care. The medical establishment only knows what they have been taught which is basically pharmaceuticals. It is quite encouraging to see people explore other avenues of treatment now. Another point to remember is that the body needs rest for recovery, just a body in a coma, and getting upset over fatigue furthers the fatigue as the worry causes more stress that impacts the body, requiring more rest. Just something to consider.
I had a traumatic brain injury in Jan 2009. I experienced severe fatigue since my accident. I went for neuro feedback and neurological chiropractic adjustments ( still attending) two months ago and have been surprised by the results. My fybromyalgia or permanently aching muscles improved immediately, fatigue has considerably eased and my brain fatigue and capability now seems to be improving also. I had no real expectation, was not promised any miraculous cure but something has definitely occured.
I suffered a serious horse accident and thus could not finish Harvard. Five years later I found a lady in energy medicine after every possible try in the medical and alternative medicine arenas. I had TREMENDOUS recovery from this!! Learning RX is also phenominal and honestly there are not that many seriously injured that return pretty darn close to where they were before. Feel free to email me at lauraj.campbell45@yahoo.com. I plan on having a documentary about my story and raise awareness as to my recovery and give hope to others!!
Try looking into Maca to address Endocrine imbalance problems.
Could it be vestibular dysfunction from the impact? Do you have balance issues but they are subtle? I did. Vestibular rehab helped. This is something good Dr's missed. Because. I was having headaches an net ordered a hearing test and vestibular test......the rehab therapy came from own research. On another note I had an optometrist trained in treating brain injury eye issues.

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