“I’m So Tired My Brain Hurts” Cognitive Fatigue

Have you heard this or similar comments?

It’s real. It is termed Cognitive Fatigue. And the good news is there are strategies to help minimize it.

Before I get to the strategies, here are a couple of real life descriptions to help explain what it is like:

In an article in The Guardian newspaper Tim Lusher  described his experiences following an abscess on the cerebellum, (the part of the brain that controls movement, balance and coordination).He vividly describes cognitive fatigue:

Ah, the tiredness. That’s another thing everyone talks about. It’s not a tough-week-at-the-office tiredness that you can rally through with a couple of drinks and the prospect of a weekend lie-in. It’s a leaden blanket of exhaustion that sweeps over you – utterly undeniable, non-negotiable and unshakeable.

And this description in an article entitled “Learning to Pace Yourself” from Synapse

Those who haven’t had their brain banged around won’t understand the feeling – they’ll picture how they feel after a bad night’s sleep or a big work day. But this mental exhaustion is much more than that. It feels as though even the simple act of pushing a few sluggish thoughts through this damaged brain takes far too much energy, let alone attempting things requiring physical exertion. To make things worse, when I got tired my emotions were worse than ever – my family was already struggling with my temper, depression and poor social skills. What little control I had in these areas just flew out the window once fatigue set in.

Cognitive fatigue is common after a brain injury, whether mild, moderate or severe.

The brain is working harder to keep up all its functions, even ones that were once second nature. Eventually it is like an overload button, the brain needs a rest. Without rest it can lead to headaches, or becoming irritable, confused and sometimes increasing problems with behaviour.

What can you do about it? Well even understanding what it is, gives you clues about how you could assist a person manage it. Here are some ideas to get you started.


What Can You Do for Cognitive Fatigue?

Below is a list of strategies you might find useful to work with. Decide what might work with the person you are supporting and their network. Just choose the key strategies that might suit. Keep the change manageable for everyone involved.

  • Balance the daily routine with quiet times, rests, or restful activity; building in whatever rest time the person needs whether a short nap or a longer sleep time.
  • Help family and friends to understand cognitive fatigue and know that it is as a result of the brain damage, it’s not laziness or deliberate.
  • Plan ahead to allow opportunity for sleep and rest, program this into the daily plan before fatigue occurs.
  • Work out what time of day is best for activity. We often talk about whether we are a morning, afternoon or evening person, this is important in planning to minimize fatigue.
  • Allow extra time to complete work that requires extra concentration and effort.
  • Plan ahead for demanding activities, or when going to special events. Allow for extra rest time and / or quieter routines before and after.
  • Use aids, equipment, and technology to reduce effort wherever possible. For instance if the person has mobility aids encourage their use to minimize fatigue.
  • If helpful see about shorter days for school or work; and with frequent breaks according to need.
  • Encourage saying no to activities or demands that are not important, or that would overly fatigue them.
  • If there are a number of activities or things to do on a day, work out priorities and tackle the important, or interesting tasks first.
  • As much as possible have familiar routines and surroundings, which reduces to effort and need to concentrate.
  • Take notice of what factors contribute to fatigue and work out how to manage these as much as possible. This might include the effect of medication, weather, or illness, people, places.
  • Be aware that sensory overload can impact on fatigue; situations such as a busy shopping centre with lights and noise. Limit or avoid these situations.
  • Maintain optimal health and fitness. Take care with exercise that it is does not itself cause fatigue.
  • Develop ways to manage fatigue if and when it occurs. Think about at home and when out.
  • You as a supporter can minimize fatigue by assisting where necessary, and where appropriate. Carrying out tasks, understanding what needs to be done, assisting to maintain agreed rest routines.


When looking at ways to manage fatigue remember it is better for a person to try and manage cognitive fatigue before rather than after it happens. Plan to prevent rather than manage after fatigue occurs.

Finally remember to always work with the person and their support team when developing any strategies. Each person will have different needs and different responses. This may change over time. Consistency is a key.

Please share any successful (or unsuccessful ways) you might have seen cognitive fatigue managed.

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23 Responses to “I’m So Tired My Brain Hurts” Cognitive Fatigue

  1. Donna March 16, 2013 at 2:29 pm #

    Okay. So it was hard work. But look at the result! Fantastic. Congratulations Mel. Exactly what is needed.

    • Melanie March 20, 2013 at 6:48 pm #

      Thanks as always for your support and confidence.

  2. Mike Strand March 21, 2013 at 1:53 am #

    Excellent post! I am 25 years post TBI and I still have these fatigue issues. I manage them pretty well to the point that much is second nature, but it is good to see it clearly laid out as it reminds me that there are a lot of effects of cognitive fatigue and that cues me in to identify them when it is happening so I can quit beating myself up over things when I get confused or unreasonable.

    For example: Last year I lost my job of 27 years and am now back in school. I got home last night and had gotten a really bad grade on a paper that I thought I had nailed. I lay there in bed wondering if I was out of my league thinking I could go back to school, along with all the other overwhelmed failure thoughts that crowd in on me when I am tired. When I woke this morning and re-read the instructors comments, she had said that I had completely misunderstood the assignment and that I could resubmit it and to talk to her if I had any questions. As soon as I read that I kind of had an “Aha” moment and saw what I should have done and why she said I missed the mark.

    This is an example of how cognitive fatigue can have a far reaching effect. I had read all that the night before, but I hadn’t understood what she was saying. I got hung up on the part where I had failed and saw no further. Fortunately, I have learned to accept and thus overcome failure, so I was not up all night tossing and turning like I would have been years ago, which would have created a week long crisis as I let the fatigue keep me from resting and recovering and dealing with the problem effectively.

    • Melanie March 25, 2013 at 6:51 pm #

      Thanks Mike, This is a great example of how fatigue can have a significant impact and highlights ways to manage it. I hope others benefit from your experience.

    • Marie G. Cooney October 25, 2013 at 6:33 am #

      Mike, you are an inspiration to many. Best wishes on your return to school. Maybe you’d like to join us at Courage some second or fourth Tues at 6:30-8 pm. You would be a very welcomed member!

  3. Marie G. Cooney October 25, 2013 at 6:36 am #

    Dear Melanie,

    With the holidays soon upon us, this is the perfect reminder for those of us with Brain Injures, as well as our friends and families. I co-facilitate a BI group at Courage Center in Golden Valley, MN. I would love to use this blog next month! Thanks for writing it.

    Marie G. Cooney

    • Melanie Atkins October 25, 2013 at 7:22 pm #

      Marie you are most welcome to share any information on the blog and the blog itself with people who are interested. It is great to know it is helpful. Thankyou for taking the time to post these comments. Regards Melanie

  4. Marie G. Cooney October 25, 2013 at 6:50 am #

    Sensory overload of lights, sound, smell, conversations and more is very difficult for me. I wear a visor and Churada framed bi-focal glasses, which also have an insert to block out extraneous light and make glasses even darker, when necessary. I also carry earplugs to dampen loud noises. And I ask people to not participate in “Ping-Pong” conversations, which are very difficult for me. Instead, please let ONE person at a time talk. Even those without brain injuries can appreciate this and the metaphor helps people remember that conversations can be as fatiguing as a strenuous athletic work out.

    During the holidays, having even one person who understands this is so important. I want to be able to spend time with family and friends, but I can get fatigued so easily. It is best for me to have a plan BEFORE getting together with others.

    For example, asking someone if there is a quiet place to rest if I get tired, allows my loved ones to carry on activities, while I also take care of my own needs. Sometimes, it’s a good idea to let others know they can do things you enjoy, and that you are willing to live vicariously by talking about the whole party later. Everyone wins and nobody loses.

    • Melanie Atkins October 25, 2013 at 7:21 pm #

      Thanks so much for your thoughts Marie. Great strategies in here that might be helpful for others. Thanks for taking the time to share them.

  5. Lin May 5, 2015 at 4:10 am #

    I don’t know if I’ve had brain damage, but this is the kind of fatigue that started just in the last 2 months for me. I haven’t had a head injury, not since I was 9 anyway, but it’s possible that MS or an unnoticed stroke has hurt my brain; I’m supposed to consult with a neurologist soon to discuss my new neurological symptoms (again only occurring in the last 2 months) and figure out what’s going on. Meantime, I have to just deal with all the stumbling, spasms, weakness, vision changes, headaches, vertigo, fatigue and more. The fatigue is like this: my brain always thinks it is (I am) tired, even when it’s clear I am not. I have a permanent light, “fuzzy” feeling in the center of my head. My head decides when I lay down and shut my eyes, no arguing. If I argue, I involuntarily collapse. Those coping strategies outlined in this article sound good… except that they are based on preventing and/or planning ahead for such fatigue. What about people in my situation, who NEVER get a break from the fatigue? Even as I type this, there’s a bizarre feeling in the left side of my face and head and I am laying in bed because my body won’t let me sit up.

    • Melanie Atkins May 6, 2015 at 12:41 pm #

      Thankyou for sharing your experience. I agree my article was general and it is more about preventing fatigue. I always struggle with how much to cover and whether it is relevant or not. It sounds like your fatigue is more constant, and the cause still unknown. As you have suggested consultation with someone who can help diagnose your issues, such as a Neurologist might be a good first step. Thanks so much for sharing you story given you are already coping with so much. Regards Melanie


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