Imagine waking up in the morning, making yourself a simple breakfast and sitting down to read the news. But by the end of breakfast, you’re completely drained. What’s more, you have no energy left to get through the day. Even simple tasks, like getting up to let the dogs out into the backyard or folding a load of laundry is challenging. That’s an example of what post-concussive patients experiencing neurofatigue go through.
What Is Neurofatigue?
As described by Brainline, a national project offering authoritative information and support to those affected by brain injury or PTSD, neurofatigue is a “decrease in concentration, focus, memory, recall, and word retrieval.” Sometimes this symptom is called brain fog, neurological fatigue or mental fatigue.
When the brain suffers a traumatic injury and its structure is damaged, it will start to go to work to repair itself. This amazingly powerful brain, when some parts of it are injured, will actually work harder than normal and use more brain cells to process information after a traumatic brain injury (TBI), such as a concussion. The brain will work so hard, in fact, that it will pull resources away from doing ordinary functions (like reading emails or letting the dogs out) leaving you feeling mentally fatigued.
TBI, Post-Concussion Syndrome and Neurofatigue
Thirty years old and a mother of four, Hannah (who asked that only her first name be used), suffered a traumatic brain injury (TBI) as a result of a car crash. Four months later, she still struggled with neurofatigue on a daily basis. She describes her life before and after the crash:
Last year I could drive an hour and a half to the shore, spend all day at the beach chasing my kids around, drive back and then the next day clean the whole house. Now, if go to the lake 10 minutes from home, sit in the shade for an hour and then have a family dinner at home, I’m fatigued for 2 days.
“Fatigue, as in a kind of overwhelming mental exhaustion, is probably one of the top three symptoms my patients report,” says Mid-Atlantic Concussion Alliance Medical Director Vincent Schaller, MD, DABFM, CIC. “It’s right up there with headaches and vision problems.” Indeed, neurofatigue is one of the most common and debilitating symptoms experienced during the recovery process, according to the Brain Injury Association of America (BIAA). They report as many as 98% of brain injury patients have some form of fatigue.
Carl Jackson is a former police officer who was forced to retire after suffering a TBI while in the line of duty, and we shared his story in January of 2022. His injury was back in 2005, when TBIs were still largely misunderstood and often treated incorrectly, or not at all. Within 24 hours of sustaining his concussion, Carl reported experiencing extreme fatigue. But instead of clearing up after a few days or weeks, his bouts of neurofatigue would go on for years (along with mini-seizures and other PCS symptoms), and impact his quality of life.
An Invisible Injury That Is Very Real
To the uninformed eye, neurofatigue can be mistaken for laziness, and a lot of TBI sufferers worry about being perceived that way. But the lack mental energy caused by neurofatigue is not the same as a lack of motivation. Neurofatigue, like so many symptoms of post-concussion syndrome (PCS), can be invisible. Sometimes, sufferers will look confused, fidgety and angry without realizing it.
Neurofatigue can be a very debilitating symptom for post-TBI and PCS patients. Beyond the actual fatigue experienced, living for weeks or months on end of feeling completely wiped out after simple tasks, like folding some laundry or reading a newspaper story, can leave some people feeling depressed or anxious. It can be hard to accept that their brain is taking longer to heal than they thought, and their patience can be worn thin.
Family and friends can really be helpful in tracking neurofatigue and its impact. According to Headway, a British organization dedicated to research and improving the lives of brain injury patients, that’s because neurofatigue can be difficult to recognize in oneself. That’s in part because of problems with sensory feedback happening in the injured brain. Enlisting the help of family and loved ones can give a fuller picture and provide a needed support network. This would be in addition to, and not in place of, proper treatment and monitoring from healthcare professionals experienced in treating concussions, TBIs and neurofatigue.
What to Do if You Suffer From Post-Concussion Fatigue
Dr. Schaller has been treating PCS patients with neurofatigue since 2010. He likens the injured brain to an old cell phone. “The patient with a traumatic brain injury,” Dr. Schaller cautions, “needs to be careful not to use too much energy at once if they want to last all day without needing an extra charge. Like an old cell phone that needs a charge by noon, a concussed brain runs out of juice much earlier in the day than the non-concussed brain.”
Dr. Schaller guides his patients through the MAC Alliance Concussion Protocol that he has developed. This recovery regimen includes brain rest requirements that instruct patients to refrain from things such as physical work, reading or academics. Daily recommendations for early-stage recovery patients include:
- Stay well hydrated
- Get 7 to 8 hours of sleep at night, starting no later than 11pm
- Take daily walks
- Wear sunglasses for light sensitivity
- Limit any travel to 30 minutes per day, in any vehicle
- Avoid texting and computer usage (no social media!)
- Limit television to 30-60 minute increments, at a maximum of three hours per day, on a large screen so long as symptoms do not worsen
- Limit daytime naps to less than 30 minutes
- Listen to soft music if you like, but without ear buds
About Mid-Atlantic Concussion Alliance
If you are experiencing neurofatigue, or any other PCS symptoms, concussion specialists are available to help you. At Mid-Atlantic Concussion (MAC) Alliance, we have a network of certified medical professionals located throughout Delaware, Maryland, New York, New Jersey, Pennsylvania and Virginia. We are committed to the diagnosis, treatment and long-term care of concussions and traumatic brain injuries. For further information, click here to find the nearest partner to you or call us at (302) 235-8808.
