Tiredness is a common symptom in patients who have had a mild head injury. Other symptoms, such as headaches, memory and concentration problems, and dizziness, can make daily activities feel effortful or even overwhelming, leading you to feel more tired than you usually would. People often say that it is the tiredness and fatigue that really holds them back day to day in the first days and weeks after a mild head injury.
In normal everyday life, we feel tired when we have been very busy, or had a long day, but will usually feel much better after resting for a while.
The sort of fatigue people get after a mild head injury can come on after less activity than normal, and can seem more severe and longer lasting. Most people who feel tired in this way will try to take more rest, in the hope that this will make the tiredness better.
However, rest often doesn’t help. Too much rest, such as spending whole days in bed, is not helpful for the sort of fatigue that you can get after a mild head injury. It can in fact make you feel worse, and can make you lose physical fitness which in turn can lead to tiredness feeling worse. Too much rest can also cause joint stiffness, back pain, loss of confidence, and social isolation. Loss of physical fitness in itself can add to tiredness, and a ‘vicious cycle’ can arise of tiredness – rest – loss of fitness/back ache/muscle stiffness – tiredness.
What Can I Do to Help Myself Get Better?
Fatigue after a mild head injury gets better by itself over time. However, there are a few things you can do to help this recovery.
1. Instead of avoiding usual activities, try to gradually get back to your normal routine.
People who are worried that they have sustained serious damage sometimes avoid usual activities. This does not help them to recover, but in fact can lead to loss of confidence and physical fitness and so makes fatigue worse. It is important to remember that the symptoms of mild head injury improve over time and do not cause longstanding problems or future dementia. Getting back to usual activities will help fatigue to gradually improve.
2. Don't do too much at once. Be realistic and gradually increase activities.
However, doing too much in a single day, to start with, might make you feel very tired indeed, maybe even so much so that you don’t feel up to much the next day. If you are someone who is used to being busy and active, getting a lot done, it is easy to get into an unhelpful cycle of busy days with days in between where you feel totally exhausted. When you are in this pattern it can be difficult to make any forward progress and can feel like you are back to ‘square one’ a lot of the time. This pattern is more likely to happen if you dwell on ‘all or nothing’ thoughts, like ‘If I can’t get back to working a whole day and then running five miles, I’m not going to do anything at all.’
3. Improve fatigue by improving your physical fitness.
If your fatigue has been around for a while, and especially if you have taken a lot of rest and time out from your daily activities, you may have lost some of your usual physical fitness – muscle strength and cardiovascular (heart and lungs) fitness. This can make tiredness worse, and can feel difficult to tackle. It can be hard to feel like exercising when you are tired. However, improving physical fitness is one of the best ways of improving fatigue in the long run.
The best way to get back your fitness and to get out of the ‘boom – bust’ cycle is by starting to do some gentle physical exercise for a short time every single day and then gradually increasing the length of time that you spend exercising over the following days and weeks. This is sometimes called graded exercise. Exercise is safe and effective in helping recovery from a mild head injury and will not cause you any damage.
Medications and Alcohol
Certain things can make fatigue worse. Sedative medications, such as sleeping tablets, and strong painkillers such as morphine, those including codeine, or tramadol, can all make existing tiredness worse. These medications are best avoided if fatigue is a problem for you after a mild head injury. Alcohol can also worsen tiredness.
Depression and Anxiety
Sometimes, fatigue can be a symptom of depression or anxiety. In fact, fatigue is one of the main symptoms of depression, often together with feelings of enjoying things less, or feelings of emptiness, but not always low mood – you do not have to feel sad or low in mood to have depression. If you are depressed or very anxious, treating the depression or anxiety will usually make the fatigue better. However, it is also important to state that fatigue can be a problem after a mild head injury even if there is no depression or anxiety.
Royal College of Psychiatrists - The RCP website has a very informative page on tiredness, explaining reasons for being tired and providing all sorts of tips on beating tiredness.
How to do it:
Make your own plan, starting with the sort of activity you can manage – gentle stretches, a short walk, swimming, or cycling. Plan to repeat this activity every day, or twice a day, making small increases as you feel able. For example, you might start by walking to the corner once a day for a few days, then walk a bit further, to the shop, for a week or two, before adding in another short walk at a different time of day. To start with it might feel as though you are not managing very much activity at all, but the important thing is to have some activity every day.
When you first start exercising it is important to be aware that your tiredness might feel a bit worse in the first instance. However, if you continue to make gradual increases in the length of time you are active for, avoiding a ‘boom-bust’ pattern – you will notice that your energy levels gradually improve and that you no longer feel so tired.
If you are used to being very fit and active, continue to remind yourself that the short amount of exercise that you are doing is a worthwhile and important step towards getting back to your previous level. Challenge ‘all or nothing’ thoughts like ‘There is no point if I can’t run five miles / work five days a week.’ Thoughts like this are unhelpful and can lead to prolonged rest and loss of fitness, so in fact stopping you from getting back to your previous level.