How Concussions Affect Males and Females Differently

When we think about concussions, perhaps the most common thing that comes to mind is American football. There’s good reason for that, as statistics show the incidence of concussion among football players of all ages is common.

But the injury also occurs at high rates in many other sports, especially those in which females participate. Furthermore, both men and women can experience a brain injury in circumstances outside of sports, and a growing body of research has indicated that females may be more prone to concussion-related complications like more severe symptoms and longer recovery times.

Concussions in Males Versus Females

In recent years, research has shown rising rates of concussions in females.

One study of more than 80,000 high school students across the United States found that female soccer players were twice as likely to suffer concussions as their male counterparts.

Another study found that girls who play soccer are at nearly the same risk of concussion as boys who play football.

“Research shows the rate of female concussions is rising more than for males,” says Angela Colantonio, PhD, director of the Rehabilitation Sciences Institute at the University of Toronto.

And while this is true in the sports world, there are many other causes of traumatic brain injury, including falls, motor vehicle accidents, and blows to the head. Dr. Colantonio says there are likely many more undocumented brain injuries among women, such as in cases of intimate partner violence.

In addition to higher rates of concussion among females, female athletes report a higher number of symptoms and more severe symptoms after brain injury than males.

One study conducted by Colantonio and a research team found that women were more likely to report headaches, dizziness, and loss of confidence after a concussion than men. Women were also more likely to report a lack of initiative and a need for supervision that became significantly problematic in daily functioning after a head injury.

In contrast, male participants in the study had a greater sensitivity to noise and more sleep disturbances than females and reported more difficulty setting realistic goals. Men also reported restlessness as a problem following a concussion.

In another study, females reported higher percentages of symptoms following a concussion. Deaths due to traumatic brain injury were also noted to be higher in pediatric and elderly female patients when compared with males in these same age groups.

Other research suggests women are more susceptible to the long-term effects of a concussion. A study of 2,000 people who suffered a traumatic brain injury determined that women were more likely than men to have symptoms, such as headaches, dizziness, fatigue, and difficulty with memory and concentration, one year after sustaining the injury.

What’s Behind the Gender Differences Seen in Concussions?

Researchers are working to better understand the differences between males and females when it comes to traumatic brain injury.

Some experts somewhat controversially explain that social gender differences account for the disparity — for example, that females may be more likely to report symptoms of concussion than males.

But research shows biology is also likely at work. For example, female athletes may be at greater risk of concussion at certain times during their monthly hormone cycles.

In a study, researchers analyzed blood samples from 144 women with concussions to determine the stage of their menstrual cycle. They found that women who were injured during the last two weeks of their cycle (when the hormone progesterone is at its highest level) had worse post-concussion symptoms than those who were in the first two weeks of their cycle (when progesterone is at the lowest level) and those who were taking contraceptive pills.

While the researchers could not prove why this happens, they have a theory. When women receive a blow to the head during the last two weeks of their cycle, production of progesterone tends to slow, which creates a sense of withdrawal that makes the symptoms of a concussion like headaches, nausea, and dizziness worse. The study authors refer to this as the “withdrawal hypothesis”; the sudden drop in progesterone when it should be high is what leads to worse concussion symptoms than with concussions that occur with already low levels of progesterone.

“Women therefore experience worse outcomes than men because men have a consistently low concentration of progesterone,” the researchers wrote.

Other research suggests neck-strength-to-head-size ratios, as well as an increase in angular acceleration at the neck, may also play a role.

Importantly, Colantonio notes that the majority of research done on gender differences in traumatic brain injuries is based on athletes, which may or may not translate to the general population or people who get concussions outside of sports. More scientific research is needed in this area, she says.

What Women and Parents of Girls Should Know About Concussions

While scientists try to better understand how males and females are affected by concussions, there is currently a lack of female-specific guidance, protocols, and plans of care for girls and women with a traumatic brain injury.

Because of this, Colantonio says that some females may doubt themselves when the speed of recovery and severity of symptoms following a concussion do not match the experience of males they may know.

It’s paramount, she says, that parents, doctors, coaches, and school staff listen to girls and women and the symptoms they report after a brain injury.

“In our focus group with women with more severe levels of injury severity, women with brain injury felt dismissed by care providers,” she says. “It’s important for practitioners and parents not to dismiss these symptoms.”

Research is underway to determine the effectiveness of patient education materials that take into account sex and gender differences in concussion outcomes.

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Concussions in Males Versus Females