Do Concussions Affect Women Differently Than Men?
By Martha McLaughlin
Women’s hormones fluctuate more than men’s do, adding variables to a research equation. Due to this, it has often been the practice of medical researchers to study men only, and assume, sometimes incorrectly, that the results apply equally to both sexes. The field of concussion research has traditionally focused primarily on male subjects for an additional reason: In the sports arena, concussion risk is highest for contact sports, such as football and boxing, which are dominated by males. As practices have changed and research has expanded to look at female subjects, variations have been discovered among the sexes in both the frequency and symptomatology of concussions.
Concussion Risk in Athletes
People can receive concussions from a variety of activities and events, including car accidents and work-related injuries. Sports participation is a common cause. The 2015 movie Concussion highlighted the risk that professional football players face and raised public awareness of the issue. Less understood is the risk for other athletes of both genders, even in sports considered non-contact.
Concussion risk is a significant issue for student athletes at both the high school and collegiate level. A study reported in The American Journal of Sports Medicine examined the number of concussions among high school students participating in 20 different sports. The sport with the highest number of concussions was boys’ football, followed by girls’ soccer, boys’ wrestling and girls’ basketball. In examinations of sports with similar rules for male and female players, girls were found to have a higher concussion rate.1
Research on collegiate athletes has found a similar pattern. In an article published in Scientific American, Zachary Kerr, who directs the Injury Surveillance Program for the National Collegiate Athletic Association (NCAA) notes that concussion rates per 1,000 athlete-exposures are “much higher” in female participants. In soccer, the rate was 6.3 for females versus 3.4 for males, and basketball was similar, with a female rate of 6.0 and a male rate of 3.9.2
Concussion Symptoms in Females
In addition to being more likely to sustain a concussion, females report more concussion-related symptoms than males do, and may take longer to recover. In a report for the NCAA, Dr. Brian Hainline notes that female athletes report a higher degree of lightheadedness, headache, fatigue, impaired concentration and visual hallucinations. Their reaction time is slower and cognitive decline greater than what is experienced by their male counterparts.3 Kerr notes that among student athletes, females are more likely to report nausea, drowsiness and sensitivity to light and sound.
Why Women May Experience Concussions Differently
There are multiple theories explaining the concussion differences between the sexes. It is likely that muscle mass and strength play a role in the concussion rate, specifically as related to neck size and strength. It is also likely that hormonal differences come into play.
Hainline notes that the hormonal fluctuations experienced by females in their childbearing years may contribute to the development of migraines, which women between puberty and menopause experience at about four times the rate that men do. Migraines and concussions both include an excitatory electrical phenomenon in the brain which is followed by an inhibitory one involving waves of depressed electrical activity. As the waves spread, so too does neurological dysfunction. Female athletes who are susceptible to migraines are more likely to experience a concussion than other female athletes are. Further illuminating the hormonal connection, a study published in The Journal of Head Trauma Rehabilitation found that women in the high-progesterone phase of their menstrual cycle at the time of their injury scored more poorly on measures of neurological functioning and quality of life than did other women.4
Preventing and Treating Concussions
Currently, preventing concussions is largely a matter of avoiding high-risk activities and using well designed safety equipment. Because damage to the brain can be cumulative, it is important to recognize concussion damage early and to allow adequate time for recovery. Some experts recommend complete avoidance of television, computers, phones and homework after a concussion to allow the brain sufficient rest and time to heal.
In the past, concussion severity and improvement was diagnosed largely on symptom reports. Today there are techniques, such as brain mapping, that help practitioners and patients measure brain health. Quantitative electroencephalogram (QUEEG) brain testing is similar to electrocardiogram (EKG) testing of the heart. It is a painless procedure using electrodes placed on the head to measure electrical activity.
Using brain mapping, doctors are able to determine how well the brain is healing and when it might be safe for a patient to resume normal activity. The Neuropsychiatric Center of Chicago, at Hartgrove Hospital, offers brain mapping to concussion patients. It is a valuable tool for understanding injuries, targeting interventions and helping patients reach full recovery.
1 Marar, M. et al. “Epidemiology of concussions among United States high school athletes in 20 sports.” American Journal of Sports Medicine, Volume 40, Number. 4, April 2012.
2 Roehr, Bob. “Concussions Affect Women More Adversely Than Men.” Scientific American, March 9, 2016.
3 Hainline, Brian. “Do Female Athletes Concuss Differently than Males?” NCAA.org. Accessed 10 September, 2017.
4 Wunderle, Kathryn. “Menstrual Phase as Predictor of Outcome After Mild Traumatic Brain Injury in Women.” The Journal of Head Trauma Rehabilitation, Volume 29, Issue 5, September/October 2014.
