Fatigue, Sleep Problems and Headaches

Fatigue, sleep problems and headaches are the most common (and often distressing symptoms) experienced after a traumatic brain injury. They are the symptoms that are most often related to cognitive and emotional concerns.


You may find that you tire more easily and have difficulty rebounding from busy days. You might also find that fatigue can often intensify other symptoms.

What can you do about fatigue? 

  • Be realistic and plan accordingly. Pace yourself and only exert yourself when you are the most energetic. Acknowledge you may not be able to do as much as you did before. 

  • Don’t be hard on yourself. Do what you can when you can. Try not to worry about things you haven’t achieved - notice when you have done things well and celebrate those successes! 
  • Have regular rest breaks. Build in downtime and plan to take breaks - this can help you pace yourself. 


If you find yourself struggling with sleep, first develop a regular sleep routine. Having a sleep routine helps the body prepare for going to sleep and helps you wind down before bed. You may be underestimating how much sleep you need - many people who have experienced a TBI need about 2.5 hours more sleep per night than those without a TBI. 

What can you do about sleep problems? 

  • Establish a regular routine. Go to bed at the same time each night and wake up at the same time each morning. 
  • Go to bed when you’re sleepy. Listen to your body. 
  • Avoid exposure to bright lights, screens, or the TV before bedtime. 
  • Avoid heavy meals, alcohol and/or caffeine late in the evening 
  • Create a calm bedroom cool, dark, quiet, use earplugs and blackout curtains 
  • Avoid taking late afternoon naps (or daytime naps longer than 30 minutes) 
  • Avoid exercise late in the day 

Avoid alcohol and do not use sleeping medication unless directed by your healthcare provider. Alcohol and sleeping medication can become addictive and do not work well in the long run as they do not teach your body how to sleep better. Be sure to discuss your sleep concerns with your healthcare provider. 

Often individuals with combat-related head injuries can experience post-traumatic stress symptoms that can impair sleep - such as nightmares and increased arousal. Let your healthcare provider (including mental health therapist) know if these are concerns for you. 


There are five types of headaches that are most often associated with traumatic brain injuries: 

Tension headache (most common type) - triggers include worry, stress, overwork, poor posture, and poor ventilation

  • Band of pressure around head 
  • Neck or jaw discomfort 
  • Tenderness on your scalp and in neck and shoulder muscles 
  • Onset is usually later in the day, so may prevent sleep 

Migraine headache - triggers include emotional stress, physical activity, sleep problems, fatigue, irregular eating habits and certain foods (i.e., chocolate).

  • Throbbing pain in forehead and temple 
  • May have nausea, vomiting, numbness, muscle weakness, and sensitivity to light/sound/smell 
  • Sleep may help resolve symptoms 

Post-traumatic headaches 

  • Pain that increases when touched, accompanied by a burning or tingling sensation 
  • Similar to tension and migraine headaches 
  • Occur months or years after a traumatic brain injury 

Cluster headaches - triggers include nicotine, alcohol, overwork, and emotional stress 

  • Intense pain behind the eye and one side of the face, which may move to the other side of the face. 
  • Similar too migraine headaches, but more severe 
  • Lasts between 15 minutes to three hours 

Withdrawal (rebound) headaches - triggered from withdrawal of extended use of pain medications 

  • Nausea, difficulty concentrating, depression, irritability, and restlessness 
  • No specific area of pain 

Most headaches are caused by these triggers or aggravating factors (minimize these if possible) 

  • Stress 
  • Depression and anxiety 
  • Lack of sleep or changes in sleep routine 
  • Skipping meals 
  • Poor posture 
  • Working in awkward positions or holding one position for a long time 
  • Medications used for other conditions such as depression or high blood pressure 
  • Overuse of headache medication 
  • Jaw clenching or teeth grinding 
  • Lack of physical activity 

If experiencing any, or all, of these symptoms and would like additional resources and Get Support