Brain fog - post migraine fatigue

There's a lot of different fatigues out there. I was exploring the idea that the central nervous system was the underlying cause of my fatigue but now I'm getting more interested in the response of the brain to various conditions.

So, here is what happened:

• I was generally tired but pushing myself. I am always crossing the invisible line where I do too much.
•  I really went for it. I went to a colleagues leaving party, I skipped rests, I carried on. All was well - I was waiting for the weekend to catch up.
•  I went on a computer to do some work. My brain crashed - it kind of slips on itself. Bad news!
•  I was instantly extremely tired.
•  I experienced an aura migraine that was quite disorientating.
•  I was supremely exhausted for the next 6 days - the brain would not go. I could not read, concentrate or do anything.
•  It gradually wore off but there was a definite blockage in the brain
• The rest of me was completely fine.

Now, here's my theory. The brain crashed and then it went into a self protection mode - you're too tired to carry on, so I'm stopping you causing more damage. Perhaps there is a change in the brain chemistry or the blood vessels become inflamed, but whatever it is, part of it shuts down.

Is there any you can do when this happens?

You need to respect your body and wait for the worst to pass. There's no supplement, or diet, or exercise that can help this healing process. You have to be patient. Luckily, I am still able to listen to music or watch TV with my eyes shut, and do light tasks for about 10 minutes. Beyond that, it is lying in the garden or bath or the sofa.

Diagnosing your fatigue

After all the tests have been done and after three months of being exhausted, if you have no clear diagnosis, your doctors will switch strategy and suggest you have chronic fatigue of some sort. You can read the latest NICE guidelines on this, and have a good rummage round. You can also look at other diagnosis pathways by searching them on the Internet. Regardless of the cause of the fatigue, you may also be categorised along the following lines:

- unable to do anything, basically bedbound
- can leave the house for a little bit but unable to do much
- able to do about 2-4 hours of activity per day
- able to do a simple part time job
- able to lead a semi-normal life with difficulty
- leading a semi-normal life and managing symptoms

The outlook for you is generally good:

- 80% recover and are able to lead a satisfying life
- 10% recover completely
- 10% don't recover

This does not include those of us who have an illness that is causing fatigue.

At a certain point, you will realise that you have to take responsibility for dealing with your fatigue and there is a lot of work for you to do. There are psychological issues, life issues, relationship issues, money issues, existential issues, health issues. It is quite a lot to take on board, especially when you are feeling unwell. Get as much help as you can: counselling, occupational therapy, someone to talk to, anything. Don't give up and keep trying:everything changes and you will not be stuck forever.

Definition of fatigue

Fatigue is still a medical mystery. Broadly speaking, this is what they have discovered so far: there are two types of fatigue:

- peripheral fatigue
- central fatigue

Peripheral fatigue is basically muscular tiredness, whereas central fatigue is related to the central nervous system. Central fatigue is the one we're all interested in because this is the one that affects most people with various illnesses and, if you have persistent (or chronic) fatigue, this is where you will be having difficulties.

If you have chronic fatigue symptoms, then you will go on a medical diagnosis journey where the doctors attempt to find an underlying disease process. There are three outcomes:

- they may find an underlying cause for the fatigue and, if you are lucky, they may be able to treat you and the fatigue will go away.
- they may find the cause of the fatigue but there is no treatment to alleviate the fatigue.
- they may find no cause of the fatigue and there is nothing they can do.

Ultimately, you may be left with central fatigue that you have to manage yourself.

Having lived with fatigue for many years, I can tell you that there are different types of fatigue mechanisms at play and it seems like one broad definition (central fatigue) is not enough - the fatigue has a different feel to it depending on what goes on. Here are some examples:

- there is the 'sick to the core' fatigue - this is the worst kind and it feels like you're on your way out
- there is the fatigue that 'never goes away' - you go to sleep and it's still there in the morning
- there is the normal tiredness - a busy day and you need a rest
- there is insomnia fatigue - you didn't get enough sleep and you feel worn out
- there is complete exhaustion - you feel like you are going to collapse, most unpleasant
- there is mood fatigue - this is when you feel depressed
- there is hangover fatigue - you've taken medicine or something that makes you weary next day
- there is post exertion malaise - you did something physical or mental and now you are tired out

All these things make you feel tired but they have different qualities to them, and you would expect different underlying causes, but let's not go there just yet.

Suffice to say, fatigue is a new landscape that you will need to explore and different types of fatigue need different approaches - you would not expect someone who is 'sick to the core' to start doing exercise therapy of some sort.

About this blog

I'm going to pull together everything I know about living with fatigue - current scientific research, what I know after living with it for the last 17 years, and what you might expect if you find yourself completely wiped out.

Firstly, fatigue is heterogeneous - it has diverse causes and affects people in different ways. This means it takes a reasonable amount of investigation to find the cause. 

Secondly, no-one really knows (scientifically) what makes fatigue happen - there's not a single hormone or gene that directly makes someone tired. This means that people can claim anything they like about a cure or supposed treatment because a) it might work for someone and b) there's no way to categorically say whether something works or not because no-one really knows.

Luckily, there is a diagnostic pathway to explore that helps us understand some common causes of fatigue and what we might do to alleviate the problems. This is reassuring because once you've exhausted all the likely causes of fatigue, you can move on to next step of the process.

Finally, if you've had a specific illness or operation or trauma and you have been left with fatigue then I'll be collating all the things we can do to help manage this most difficult of conditions.