Planning your day when concussion symptoms leave you exhausted
Spot the tasks that drain you most and build a daily plan you can keep
Imagine a 38 year old dental office manager whose car was struck from behind at a red light ten weeks ago. On Saturday she felt good, so she cleaned the house, did a big grocery run and had her sister over for dinner. She spent Sunday and most of Monday in bed with a pounding head.
If that sounds like your week, you have plenty of company. The CDC lists feeling tired and having no energy among the physical signs of a concussion [1]. Most people start to feel like themselves again in two weeks or so [1]. But Canada’s adult concussion guideline reports that about 28 of every 100 people (27.8%) were still dealing with fatigue three months after their injury [2].
Our page on fatigue during car crash recovery covers why you feel so drained. This article is about planning: finding the activities that cost you most, and fitting a day onto one sheet of paper.
Why everyday tasks take more out of you now
Fatigue after a concussion can feel like running out of mental or physical fuel, and it can get in the way of ordinary tasks [2].
Your brain is working harder
A handout from a University of Washington brain injury talk explains one reason. Research has found that people with a traumatic brain injury (TBI) show more brain activity than uninjured people while doing the same tasks [3]. The handout also points out that the more automatic a task is, the less energy it takes [3]. After a concussion, things you once did on autopilot, like making lunch while talking on the phone, may need your full attention.
The bill often comes later
A small Swedish study looked at what a half hour of mental work can do. It included 42 adults with long term mental fatigue after a brain injury, 20 of them after a TBI or mild TBI, plus 32 adults with no injury [4]. Everyone took thinking tests, read and answered questions for 30 minutes, then took the tests again [4].
The uninjured group did better the second time, as people often do with practice. The group with mental fatigue did not improve [4]. The authors could not fully separate fatigue from the injury itself, and the groups also differed in age [4].
The same researchers describe a long recovery time after effort as part of mental fatigue [4]. That helps explain why a big Saturday can cost you Sunday. When you plan, count the recovery time as part of the task.
Finding the activities that drain you most
Energy drains differ from person to person. One NHS brain injury team in England notes that the usual culprits involve physical or mental effort [5]. Its examples include computer work and busy places such as a mall or a restaurant [5].
Physical and mental effort can both wear you out [6]. Swedish researchers found that mental exhaustion tends to build during long thinking tasks and in places full of sights and sounds [4]. A planning tool from Canada’s children’s concussion guideline says noisy, busy settings make focus harder and use up extra energy [7]. Tiredness can also make noise and light more bothersome, so drains can feed each other [6].
Comparison compiled by Safety Behind the Wheel Foundation
Common energy drains after a concussion
| Type of demand | Everyday examples | Ways to lighten it |
|---|---|---|
| Thinking | Computer work, bills, forms, reading | Short blocks with breaks |
| Sensory | Stores, restaurants, loud rooms | Go at quiet times, keep visits short |
| Physical | Cleaning, laundry, yard work | Split into parts, rest between them |
| Stress | Insurance calls, tense talks | Plan them for your best hours |
| Mixed | Hosting, family events, a full day of appointments | One larger activity per day |
Sources: Gloucestershire Brain Injury Team [5]; Vancouver Coastal Health [6]; Jonasson and colleagues [4]; Pediatric concussion guideline tool [7]; Living Concussion Guidelines on mood, sleep and pain [2].
Make your own list
Use the list below for one week. Check every activity that raises your symptoms or leaves you wiped out afterward. Then bring the list to your next visit so you and your care team can talk about each one.
Checklist from Safety Behind the Wheel Foundation
- Screen work, such as email, video calls or online forms
- Reading, paperwork or paying bills
- Grocery stores, big box stores or the mall
- Restaurants, parties or group conversations
- Phone calls about insurance, claims or medical bills
- Housework such as vacuuming, laundry or yard work
- Cooking a full meal
- Caring for children or another family member
- Several appointments on the same day
- Exercise or therapy sessions
- Work or school tasks
- Driving, or riding in heavy traffic
Driving deserves its own talk with your care team, since it calls for focus, vision and fast reactions together.
Worksheet from Safety Behind the Wheel Foundation
My demanding activities
| Activity | How long before symptoms rise | How long to recover | Question for my care team |
|---|---|---|---|
Fill in one row for each activity you checked. Rough times are fine.
The boom and bust cycle
Many people try to get back to the same amount of activity they managed before the injury [5]. On a bad day, they do very little and rest a lot, which can wear down fitness and drive [5]. On a good day, they feel the pull to catch up on everything that slid [5]. That push leaves them worse off and needing rest again, a pattern the NHS team calls a vicious cycle [5].
The Calgary Brain Injury Program in Alberta has a short quiz on pacing. One statement says you should do all you can whenever you feel well, and the quiz marks it false [8]. The University of Washington handout adds that people often overdo it as they return to normal life, and setbacks tend to follow [3].
How much is too much?
A 2025 U.S. guideline strongly recommends a brief stretch of relative rest at first, followed by a step by step return to your usual activities as you can handle them [9]. It defines that as activity that raises your symptoms only a little, or not at all [9]. Short flares are common as you do more [9]. After one, people can usually keep going with their return, at a slower pace [9].
What counts as a little? Sport concussion experts meeting in Amsterdam in 2022 set a simple bar. On a 0 to 10 scale, a mild rise is 2 points or fewer, and it settles within the hour [10]. That number comes from guidance written for athletes, so ask your care team what limit fits you.
Pacing is different from resting all day
Long stretches of inactivity after the first few days can slow recovery [2]. The goal of pacing is an amount of activity you can repeat day after day. The NHS team calls this a little and often approach, and says fitness is likely to improve over time when it works [5].
Prioritize, plan, pace and position
Concussion programs often teach this method as the Ps. The Calgary program uses three: planning, prioritizing and pacing [8]. Some tools add a fourth, position, which means the place where you do a task [7].
Prioritize
Prioritizing means choosing what matters most and what you can manage, based on how you feel that day [8]. The children’s guideline tool sorts tasks into five groups that work just as well for adults [7]:
- Urgent: must happen today.
- Important: must happen in the next few days.
- Later: can happen this week or this month.
- Can wait: could be put off until you feel better.
- Help needed: someone else could do it.
The NHS team suggests asking which jobs are essential, which you enjoy, which someone else could do, and which could happen less often [5]. It is fine to leave your to do list unfinished some days [8].
Plan
Put your most demanding tasks at the time of day when you feel best [7, 6]. The Royal College of Occupational Therapists in the U.K. adds that routines and planning ahead save effort [11]. A written plan saves mental energy, because you no longer have to remember what comes next [7].
Pace
Break big jobs into smaller steps and spread them through the day [11]. Expect some tasks to take longer than they used to [8]. You may need to finish a task in stages [7]. On harder weeks, the NHS team suggests one larger activity per day [5].
The University of Washington handout describes a 75% rule. You do a familiar activity for about three quarters of the time you used to spend on it, then rest for 5 to 15 minutes before the next round [3]. It is one program’s teaching tool, so treat it as a starting point to discuss.
Position
Choose quiet, calm places for tasks that need focus [7]. Sit to rest whenever you can [11]. Keep what you need close at hand, and look for tools that cut down on effort, like a stool in the kitchen [11].
Putting the four steps to work
Back to the office manager. She now shops on Tuesday mornings when the store is quiet, with a list sorted by aisle. Her teenage son carries the bags in. She sits on a stool to unpack, then lies down for 15 minutes before starting lunch.
Your daily planning sheet
A plan on paper does a lot of the thinking for you. The Canadian guideline advises spreading activities and breaks through the day, and says a notebook or diary can help you plan and record them [2]. The Calgary Brain Injury Program offers a free activity journal built on the same idea. It asks you to name each task, apply the Ps, then look back at how it went [12].
The sheet below follows that pattern. Fill in the plan column the night before or first thing in the morning. Fill in the other columns as the day goes on, or at lunch and dinner if writing all day is too much.
Worksheet from Safety Behind the Wheel Foundation
Daily planning sheet
| Time | My plan | What I did | Symptoms after (0 to 10) |
|---|---|---|---|
| Wake up | |||
| Mid morning | |||
| Late morning | |||
| Lunch | |||
| Early afternoon | |||
| Late afternoon | |||
| Evening | |||
| Bedtime |
Adapted from the Calgary Brain Injury Program activity journal [12] and Living Concussion Guidelines advice on planning [2]. If numbers are hard, write better, same or worse.
A sample row
Here is how one row might look for the office manager:
- Time: Late morning.
- My plan: Pay two bills at the kitchen table, then rest.
- What I did: Paid one bill, stopped when my headache started to climb.
- Symptoms after: Headache went from 3 to 5, back to 3 after a 20 minute rest.
Compare the two columns. The Calgary journal asks whether you did the task the way you wanted and whether the plan needs to change next time [12].
Before each day starts
Checklist from Safety Behind the Wheel Foundation
- Write down the one task that must happen today.
- Put that task in your best hours.
- Add rest breaks to the sheet before you need them.
- Pick one task to hand off, delay or drop.
- Plan a quiet hour before bed.
Breaks that recharge you
Some breaks restore more energy than others. The NHS team suggests music or a meditation exercise, and says these beat watching TV or reading [5]. The Calgary program notes that you can schedule brain breaks in advance so you do not do too much in one stretch [8].
If you nap, the NHS team suggests a power nap of about 30 minutes and no sleep after 4 p.m. [5]. Going to bed at the same time each night also helps [5].
A weekly review: building up without crashing
A weekly look back shows patterns that a single sheet will miss. The University of Washington handout recommends a daily log of activity and fatigue so you can see how effort and symptoms connect [3].
Pick the same day each week and give yourself 15 minutes. Spread out your sheets and look for these clues.
Checklist from Safety Behind the Wheel Foundation
- Which time of day had the lowest symptoms most often?
- Which activities came before the worst evenings or next mornings?
- How many crash days did you have, and what happened the day before?
- Did your rest breaks happen as planned?
- How did sleep, pain or stress affect the week?
- Which one activity could you add a little more of next week?
Add a little at a time
Once you can repeat the same plan for a week or so without crashing, you can build up. The University of Washington handout suggests adding about 10% at a time once you have a steady starting point [3]. If you can do 20 minutes of computer work with only a mild rise in symptoms, try 22 minutes next week. If symptoms flare, drop back and build again more slowly, as the 2025 guidance suggests [9].
Bring a short summary to your visits
The patient version of the Canadian guideline suggests a symptom log for medical visits, so you do not forget anything [13]. Your provider may ask when fatigue happens and how it affects your life [13]. A short summary of your weekly reviews answers both questions. A family member or friend at the visit can help you remember what was said [13].
Talking with your care team about pacing
A 2026 Cochrane review, which pooled randomized trials, looked at 40 studies with 3,518 adults and children who had a TBI [14]. The authors called the evidence on fatigue treatments very limited, and said much more work is needed to find one that works [14].
Talking and teaching approaches, such as cognitive behavioral therapy (CBT), acceptance and commitment therapy and individual occupational therapy, may reduce fatigue [14]. The review judged that evidence very uncertain [14].
Guidelines still recommend pacing. The Canadian guideline lists pacing and planning of mental and physical activity among its strategies, with a Level C rating [2]. Its top evidence rating, Level A, goes to two other steps: mindfulness based stress reduction, and a concussion clinic referral when fatigue lasts more than a month [2].
Other problems that feed fatigue
The guideline names sleep problems, mood problems and pain as things that can make fatigue worse [2]. If pacing alone is not helping, ask whether one of these needs its own treatment. The patient version says to treat fatigue early, and to use any medicine only alongside other strategies, with close follow up from your primary care provider [13].
When fatigue comes with danger signs
Extreme drowsiness after a head injury can be an emergency. Phone 911 straight away, or get a ride to the closest ER, if you or the person beside you [1]:
- Has a headache that worsens over time and refuses to ease.
- Has weakness, numbness, decreased coordination, convulsions or seizures.
- Vomits again and again.
- Has slurred speech or acts in unusual ways.
- Has one pupil larger than the other.
- Gets mixed up, jittery or agitated, or stops recognizing familiar faces and places.
- Passes out, seems very drowsy or cannot be woken up.
Questions to ask your care team
Question checklist from Safety Behind the Wheel Foundation
- Which of my activities should I cut back for now, and which should I keep doing?
- How much can my symptoms rise during an activity before I should stop?
- How long should my rest breaks be, and what counts as real rest?
- How fast can I add more activity each week?
- Could sleep, mood, pain or a medicine be adding to my fatigue?
- Would an occupational therapist help me build a pacing plan?
- Has my fatigue lasted long enough to consider a concussion clinic?
- Do I need a note for shorter hours or extra breaks at work or school?
- Am I ready to drive, and are some times of day safer for me than others?
Frequently asked questions
Should I stay in bed on a bad day?
A short rest is fine, but long inactivity after the first few days can slow recovery [2]. Try to keep a small, steady amount of activity even on bad days, such as a short walk or one easy chore [5].
Are naps a good idea?
They can help. The NHS brain injury team suggests naps of about 30 minutes and no sleep after 4 p.m., so your night sleep stays on track [5].
The bottom line
Recommendation from Safety Behind the Wheel Foundation
Fatigue after a concussion is common, and it can make ordinary days feel like hard work. Planning can help you spend your energy on what matters most and avoid the crash after a big day. Start by listing your most demanding activities, then use a daily sheet and a weekly review to find a steady pace.
Take your sheets and your list to your care team. If fatigue drags on past a month or limits your daily life, ask about a referral and whether sleep, mood or pain is adding to it. Call 911 for any danger sign.
Sources and further reading
- 1Centers for Disease Control and Prevention. Symptoms of mild TBI and concussion. Updated September 15, 2025. cdc.gov/…/signs-symptoms/index.html
- 2Living Concussion Guidelines. Guideline for concussion and prolonged symptoms for adults: Section 11, fatigue. Ottawa Hospital Research Institute. Updated May 2023. concussionsontario.org/…/fatigue
- 3Dasher N. Managing fatigue after TBI. Presentation handout, undated. University of Washington Traumatic Brain Injury Model System. Accessed October 2026. tbi.washington.edu/…/Managing-Fatigue-Talk.pdf
- 4Jonasson A, Levin C, Renfors M, Strandberg S, Johansson B. Mental fatigue and impaired cognitive function after an acquired brain injury. Brain and Behavior. 2018;8(8):e01056. pmc.ncbi.nlm.nih.gov/articles/PMC6085903
- 5Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire Brain Injury Team. Managing fatigue after brain injury (GHPI1016_03_25). Reviewed March 2025. gloshospitals.nhs.uk/…/Managing_fatigue_after_brain_injury_GHPI1016_03_25.pdf
- 6Vancouver Coastal Health, GF Strong Rehabilitation Centre. Fatigue. Updated August 2019. concussion.vch.ca/fatigue-1
- 7Living Guideline for Pediatric Concussion Care. Tool 2.5: Four P’s for concussion care: prioritize, plan, pace and position. Updated October 2024. pedsconcussion.com/…/tool-2-5-four-ps-prioritize-plan-pace-and-position
- 8Calgary Brain Injury Program, Alberta Health Services. Checkpoint: the 3 P’s. MyHealth Alberta. Updated October 2024. myhealth.alberta.ca/…/what-are-the-three-ps
- 9Silverberg ND, Lee K, Mikolić A, et al. Action Collaborative on Traumatic Brain Injury Care: adapted clinical practice guideline. Annals of Family Medicine. 2025;23(6):552-569. annfammed.org/content/23/6/552
- 10Patricios JS, Schneider KJ, Dvorak J, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport, Amsterdam, October 2022. British Journal of Sports Medicine. 2023;57(11):695. bjsm.bmj.com/content/57/11/695
- 11Royal College of Occupational Therapists. Lift up your everyday: managing your energy. Accessed October 2026. rcot.co.uk/energy
- 12Calgary Brain Injury Program. Activity journal: a tool for energy conservation. MyHealth Alberta. October 2024. myhealth.alberta.ca/…/activity-journal.pdf
- 13Living Concussion Guidelines, patient version. Fatigue. Updated July 2025. concussionsontario.org/patient-version/fatigue
- 14Senior HE, Leung JH, Meehan B, et al. Interventions for fatigue management after traumatic brain injury. Cochrane Database of Systematic Reviews. 2026;(2):CD006448. doi.org/10.1002/14651858.CD006448.pub2
This article reflects the safety priorities of concussion recovery and road safety education. It offers general education, not medical advice, and cannot replace care from people who know your history. Guidance on pacing changes as research grows, so check official sources and talk with your own care team before you change your activity level, medicines or driving plans. Reviewed October 2026.
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