Other Phsyical Deficits

Headache

Headache is a common issue following brain injury and can be a long lasting problem. Headache may result from the brain injury, neck and skull injuries that have not yet fully healed, tension and stress, or side effects from medication. The type of headache depends on the source of the issue.

People with milder brain injury have higher rates of complaints of headaches when compared to those with moderate and severe brain injury. The reason for the higher rates

of headaches with milder severity brain injury is not well understood.

Headaches may be treated with over the counter medication, changes in lifestyle, therapeutic massage, heat or cold packs, or relaxation therapy. Frequent headaches may require prescribed medication such as antidepressants, anti-seizure medication, beta blockers or botox injections.

Fatigue

Fatigue is one of the more common effects of brain injury, even after a mild traumatic brain injury. The brain may have to work harder than before due to damage within the brain. Medications to treat spasticity, seizures and mood can cause fatigue. Sleep disorders and changes in hormonal levels post brain injury may also cause fatigue.

Some people may be very fatigued all the time and others may only be fatigued after mental or physical exertion.

Most people who have fatigue resulting from brain injury only experience the problem at certain times and not all the time. They have more energy in the morning and tend to be more tired later in the day. People’s levels of fatigue also depend on how much they are pushing themselves physically or cognitively, and whether they are making time to rest periodically during the day and pace themselves. The following steps may help:

• Identify the early signs of fatigue, such as becoming irritable or distracted. Stop an activity before getting tired.
• Get more sleep and rest. Set a regular schedule of going to bed and awakening the same time every day. Include some regular rest breaks or naps.
• Resume activities gradually, over weeks or even months.
• Start with familiar tasks at home or work that you can complete without fatigue. Gradually increase the complexity of each task, taking breaks as needed.
• Exercise daily. Research has shown that people with TBI who exercise have better mental function and alertness. Over time, exercise and being more active helps lessen physical and mental fatigue and builds stamina. It also may decrease depression and improve sleep.
• Improve time management:
• Plan and follow a daily schedule. Using a calendar or planner can help to manage mental fatigue.
• Prioritize activities. Finish what is most important first
• Do things that require the most physical or mental effort earlier in the day, when you are fresher.
• Avoid over-scheduling.

If a cause for the fatigue cannot be found post injury/incident and the fatigue is not improving and is long term, then the use of a stimulant medication can be considered but you would need to speak to a doctor about this.

Pain

Studies show that more than 50 percent of people suffer from chronic pain disorders in the years following a brain injury. Headaches and neuropathic (nerve-related) pain is most commonly from injury to the head and neck. The head is the most common location of pain.

Doctors can effectively treat pain by identifying it, quantifying it, reviewing the history of the person’s pain, and understanding how it limits function. Treatment of pain is a balancing act when considering medications since many medications to treat pain can worsen memory and cause sleepiness, especially with opioid and antidepressant drugs.

Patients with TBI may be even more vulnerable than other patients to the cognitive side effects of certain pain medications. Because of this, the use of non-sedating analgesics should be a first line in treating pain in patients with TBI. Mood disturbance can be caused by chronic pain or worsen chronic pain and needs to be addressed as part of treatment.

Cognitive behavioural therapy (or CBT) has been shown to be very effective at helping to relieve problems with chronic pain, it works because pain is a subjective experience, it can be enhanced or reduced by thoughts and feelings. Therefore by changing the way you feel or think about your pain the severity of its sensations can be reduced.

In severe or chronic cases a referral to a pain clinic may be considered.