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Stroke Helpline: 0303 3033 100Website: stroke.org.ukFatigue after strokeFatigue is one of the most common effects of stroke. It can make youfeel unwell and like you’re not in control of your recovery. The signs offatigue are not always obvious to other people and so they may notunderstand how you are feeling. This factsheet explains what fatigueis, what can cause fatigue after stroke and suggests ways you can helpyourself and seek support in the longer term.What is post-stroke fatigue?Everyone feels tired sometimes. It is anormal part of life and can happen for allsorts of reasons, such as if you haven’t sleptwell or have had a very busy day. Usually youfeel better after resting.Fatigue after stroke is different. After astroke, you may feel like you lack energy orstrength and feel constantly weary or tired.Post-stroke fatigue does not always improvewith rest and is not necessarily relatedto recent activity. So it is not like typicaltiredness. You might experience post-strokefatigue after a mild or more severe stroke.Here are some useful definitions of fatigueafter stroke. If either of these apply to you,you may have post-stroke fatigue:1. Over the past month there has beena period of at least two weeks whenyou have experienced fatigue, a lack ofenergy or increased need to rest everyday or nearly every day. This fatiguemakes it difficult for you to take part ineveryday activities.Stroke Association – April 20122. Since your stroke you have experiencedfatigue, lack of energy or increased needto rest every day or nearly every day.This fatigue makes it difficult for you totake part in everyday activities. (If you arein hospital this may include taking partin a therapy session or having to stop asession early because you are tired.)You might be tempted to dismiss how youare feeling or stoically carry on regardless.However if you do ignore fatigue, you couldbe storing up problems for the future and youare not giving yourself the best opportunityto recover.How common is post-strokefatigue?There have been a number of researchstudies on fatigue after stroke. In one study,two years after their stroke 10 per cent ofstroke survivors said they were always tiredand 30 per cent said they were sometimestired. In another study, at least 12 monthsafter their stroke, 50 per cent of strokesurvivors said tiredness was their mainproblem. You are most likely to experiencefatigue shortly after your stroke.1

Fatigue after strokePost-stroke fatigue can range from relativelymild to severe and the intensity of thetiredness does not seem to be related tothe severity or type of stroke you havehad. Post-stroke fatigue is just as commonafter strokes caused by bleeding in thebrain (haemorrhagic strokes) as those dueto a blockage in a blood vessel (ischaemicstrokes). We do know that you are morelikely to experience fatigue after a strokethan after a transient ischaemic attack (TIA),sometimes called a mini stroke.Even if you have made a full physicalrecovery, or your stroke was some time ago,fatigue can still be a constant problem.Some research studies show that women,older people and those who suffered fromfatigue before their stroke are the onesmost likely to experience it. However, otherstudies show younger people and thosewho were previously completely fit can alsofeel tired after a stroke. Other individualstudies made a connection between beingunemployed and having fatigue after stroke.But the relationship is not clear and moreresearch is needed.Many people describe fatigue as the mostdifficult and upsetting problem they haveto cope with after a stroke. You may notfeel able to engage fully in rehabilitationbecause you feel so tired. It can affect yourability to regain your independence in dayto-day life and it can be difficult to return towork or to socialise again and enjoy everydayactivities.It can also affect your quality of life andrelationships, as family and friends may notunderstand how genuinely exhausting thefatigue can be.2Why do I feel so tired?It is likely that a mixture of physical andemotional factors are contributing to youexperiencing fatigue after stroke, eventhough we don’t fully know what makessome people have fatigue when others donot. The main reason for you being tired issimply that you have had a stroke.How you might feel in the early stagesIn the early weeks and months after a strokeyour body is healing and the rehabilitationprocess takes up a lot of energy so it is verycommon to feel tired.You are also more likely to have lost strengthand fitness whilst being in hospital or asa result of the stroke, although this doesnot always mean you will have post-strokefatigue.How you might feel later onIn the long term, having a physical disabilityalso means your energy is being used indifferent ways. For example walking andcompleting other daily activities may welltake up much more energy than they didbefore your stroke, making you more likely tofeel tired.Emotional changesFeeling depressed and/or anxious iscommon after a stroke. Many people whosuffer from fatigue after stroke, also feeldepressed or anxious. However, althoughmost people with depression do feel tired,not everyone with fatigue is depressed. Ifyou feel your mood is low or you are feelingconstantly irritable or tense then don’tignore it. Your GP can prescribe medicationStroke Association – April 2012

Fatigue after strokeand/or refer you on for support and advicesuch as counselling. See our factsheets F10,Depression after stroke and F36, Emotionalchanges after stroke for more information.a new medication. Never stop taking yourmedication suddenly because you think itis making you tired – some medication hasto be stopped gradually. Talk to your GP orstroke specialist for advice.Other factorsOther factors that can affect how tiredyou feel include sleeping problems suchas insomnia and sleep–related breathingdisorders (such as sleep apnoea); eatingproblems; anaemia (iron deficiency);diabetes or an underactive thyroid gland.Some medication also causes fatigue.For example, beta blockers for high bloodpressure, drugs for epilepsy, pain and antidepressants can all cause fatigue.It has also been suggested that fatiguemay be associated with inflammatory cellsor hormones (such as cortisol) that aredisturbed by the stroke.What treatment is available?There is no specific medication to treatpost-stroke fatigue. However, there area lot of things you can do to manage thecondition.Managing your fatigueBelow are some suggestions to help youmanage your fatigue. These include tips tohelp you with any emotional problems (forexample frustration, loss of control andworry) as well as practical problems (lessactivity, reduced social life, impact on workand disturbed sleeping pattern). Being tired is very common after a stroke.It can happen to anyone, so remember itis not your fault. Your tiredness may not be obvious toother people so they may not understandhow you feel. This may be frustrating foryou. Show your family and friends thisfactsheet to help them understand whatyou are going through. They can then helpyou deal with it.Getting a proper diagnosis and finding out ifthere are any specific causes for your fatigueis the first step. Give yourself plenty of time. It can takemany months before post-stroke fatiguestarts to lift. The more you push yourselfthe worse you are likely to feel. Acceptingthat it takes time to improve can help youto cope better.Your GP or stroke nurse can check if thereare any medical conditions that could beaffecting your fatigue. Some can be pickedup with a blood test and can be treated. Keep a written or visual diary of how muchyou are doing each day. Over time thisreally helps to remind you of the progressyou’ve made.Reviewing your current medication is alsoworthwhile. If your fatigue is at least partlycaused by side effects of your medication, itusually improves with time or once you start Don’t push yourself to do too much ifyou’re having a ‘better day’. Although it istempting, it may leave you exhausted forthe next day or two.Stroke Association – April 20123

Fatigue after stroke Celebrate your successes. Many peoplefeel frustrated by what they can’t do andforget to feel good about what they havestarted to do again. Learn to pace yourself by taking properbreaks before or after doing things. Evengentle activities like talking with friends,a car journey and eating a meal can betiring. Listen to your body. If you are exhaustedduring the day then rest. This could eitherbe sitting or lying down or sleeping. Thereis no rule about how much time to rest for.However, if you are not sleeping at nightthen try resting less during the day. Don’t make it hard for yourself by tryingto do all the things you used to, or at thesame speed. It can be helpful to loweryour expectations of what you canachieve for a while, so you can build upstamina and strength again slowly. Find out how much you can do in a dayand stick to it. For example, if you canachieve about four hours of activity a day(with rests in between) without being tootired then that is the right level for you. Ifyou do too much, you will probably soonrealise as you will need to rest more orhave to spend a day in bed to recover. Build up stamina and strength slowlyor you may well feel you are goingbackwards, so increase your activitygradually. Start to wind down during the evening andget into a bedtime routine. Try to maintain some level of exercise,as regular exercise may help to improve4fatigue. Start gently, for example avery short walk or a few minutes on anexercise bike, and slowly build up withoutoverdoing it. Eat healthily. Carbohydrates such asbread and pasta are good sources ofenergy and try to eat at least five portionsof fruit and vegetables each day. If you arenot eating enough then ask your GP torefer you to a dietitian. See our factsheetF8, Healthy Eating and stroke for moreinformation. Seek support. Fatigue can be veryworrying and upsetting and just knowingit is because of the stroke can help. Yourlocal stroke team, GP or occupationaltherapist can help put you in touch withdifferent types of support, for examplestroke clubs, counselling, relaxationprogrammes, exercise groups oralternative therapies. Contact us fordetails of stroke clubs and other supportin your area.Can I go back to work?Most people want to return to work if theycan. Here are some pointers for givingyou the best possible chance of doing thissuccessfully. Your workplace could be assessed byan occupational therapist. They willlook at whether it’s necessary to adaptany equipment you use or change workpractices. If you are not currently seeingan occupational therapist, your GP canrefer you to one. Give yourself plenty of time to recoverfrom your stroke before going back towork. Putting pressure on yourself willStroke Association – April 2012