Key messages
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Medications (such as melatonin, growth hormones, brain stimulants, atorvastatin, or dopamine and serotonin regulators) likely reduce fatigue after a traumatic brain injury.
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Other treatments, such as talking therapies, sensory stimulation, and counselling, may reduce fatigue after a traumatic brain injury.
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Future studies should involve more people, including children and young people. They should investigate different kinds of treatments in different settings, and the severity and causes of traumatic brain injury.
What is traumatic brain injury?
Traumatic brain injury is damage to the brain following a bump or blow to the head. The injury might result from a traffic accident, fall, assault, sports injury, or an explosion. People with traumatic brain injury might experience headaches, become forgetful, and have difficulties sleeping and moving. They may also experience fatigue, which is defined as an overwhelming sense of tiredness unrelated to previous effort, which does not usually improve with rest. Fatigue makes it hard for people to concentrate and perform everyday activities, which affects their quality of life.
How is fatigue after traumatic brain injury treated?
Treatments for fatigue vary because the causes and symptoms of fatigue may be very different. Treatments include medication to stimulate or protect the brain, and hormones and antidepressants to help people sleep and improve their mood. Treatments that don’t involve medication include counselling, education, behavioural therapy and exercise.
What did we want to find out?
We mainly wanted to find out if different treatments reduce fatigue in people with traumatic brain injury. We were also interested in the effect of the treatments on people’s mood, memory or attention, quality of life, and sleepiness.
What did we do?
We searched for studies that randomly assigned people to receive treatment for fatigue, usual care (that is, no specific treatment for fatigue), or a placebo (dummy) treatment. We also looked at studies that compared different treatments. We compared and summarised the results of the studies and rated our confidence in the evidence, based on factors such as study methods and sizes.
What did we find?
We found 40 studies with 3518 adults and children living with traumatic brain injury. The studies took place in 12, mainly high-income, countries in Europe, North America, and Oceania. They were conducted in different settings, including medical centres, rehabilitation clinics, military bases, clinical research facilities, and hospitals.
Main results
Fatigue
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Medications likely reduce fatigue after a traumatic brain injury (8 studies, 395 people). Medications included melatonin, growth hormones, psychostimulants, statins, and dopamine regulators.
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Other treatments (without medication) may reduce fatigue after a traumatic brain injury (31 studies, 2203 people). Treatments included cognitive behavioural therapy, technical-enhanced training, functional skills training, sensory stimulation, electrical/magnetic stimulation, acupressure, counselling, acceptance and commitment therapy, individualised occupational therapy, cognitive symptom management rehabilitation therapy, aerobic exercise, prescribed light exercise, location of exercise, vestibular rehabilitation, health visits, and multi-interventional therapies.
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For treatments with medication, there were some reported adverse (unwanted or harmful) events that are specific to particular studies. For other treatments (without medication), adverse events were often not reported.
Fatigue-related symptoms
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Medications may make little or no difference to depression, anxiety, processing speed, quality of life, and daytime sleepiness (21 studies, 1016 people).
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Of the treatments without medication, only cognitive therapy showed any noticeable effect; it may reduce anxiety (2 studies, 57 people).
What are the limitations of the evidence?
We have limited confidence in the evidence due to the small numbers of people in the different studies, and the variation in settings, treatments, ages of participants, and the severity and causes of traumatic brain injury.
How up to date is this evidence?
We searched for studies up to 12 February 2025.
閱讀完整摘要
目的
To assess the effectiveness of pharmacological and non-pharmacological interventions for fatigue in people who have experienced a TBI.
搜尋策略
For this review, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO. We also searched relevant conference proceedings, and we searched ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) for ongoing trials.
The most recent searches were conducted on 12 February 2025.
作者結論
There is very limited and moderate to very low-certainty evidence from RCTs about treatments to reduce fatigue after TBI. Despite the prevalence of fatigue post-TBI, we lack high-quality studies that evaluate interventions to improve this disabling, but potentially treatable, symptom. There is a need for considerable further work to identify an effective treatment for fatigue in people with TBI.
Funding
This Cochrane review had no dedicated funding.
Registration
Protocol available via DOI: 10.1002/14651858.CD006448
