But new research is disproving that notion. It turns out that traumatic brain injuries (TBI), including concussions, or mild TBIs (mTBIs), affect women differently. Recent studies have shown that women take longer to recover from TBI, report more symptoms, and receive more concussions than men in similar sports. Hormones and the physiology of women’s necks and upper bodies are two possible reasons why women experience concussions differently than men. Here are five ways in which concussions are different in women:
1. Women Experience Longer and More Severe Symptoms Than Men
Tracey Covassin, PhD, an associate professor and director of the undergraduate athletic program at Michigan State University in East Lansing, studies concussions in female athletes. In her research, she has found that women have more severe symptoms than men and take a longer time to recover. “Women actually had symptoms three to four weeks later, where typically the males recover 10 to 14 days after [a head injury],” Dr. Covassin says. “Women had neurocognitive impairments a lot longer than males and had difficulty remembering and concentrating.” Covassin explains that females may take longer to recover because of neuroanatomical differences in the brain compared with men, adding that females have slower nerve signals while males have faster nerve impulses in their brains, which could lead them to have a quicker healing process.
2. Women Sustain More Concussions During Practices and Games Than Men in Similar Sports
In previous research, Covassin found that women in college soccer sustained more concussions during practices and games than men in the same sport. Soccer was also found to be the women’s sport with the highest rate of concussions, over basketball, lacrosse, softball, and gymnastics. She attributes this to the nature of soccer, in which players often collide with each other accidentally. She also says that women could be more at risk of concussions than men because they have a greater “ball-to-head size ratio,” or smaller heads compared with the ball. “There’s a greater transmission of forces that are occurring,” she says. Heading the ball continuously and playing in a sport with no helmets or protective gear could also lead to more head injuries.
3. Weaker Neck Muscles in Women May Result in More Brain Injuries
Researchers say that women have a higher risk of receiving concussions because they typically have weaker neck muscles. One study published in the journal Medicine and Science in Sports and Exercise found that female soccer players had a significantly greater “head-neck angular acceleration,” which is a type of biomechanical measure of head impact, and head displacement than male soccer players. Angular acceleration is thought to be damaging to people’s brains and a cause of brain injury. Hunt Batjer, MD, professor and chair at the department of neurological surgery at the University of Texas Southwestern Medical Center in Dallas, and past cochair of the National Football League Head, Neck, and Spine Committee, says that when a woman’s head is hit, her neck and shoulders cannot support the impact as well as a man’s. “Most women athletes are not as heavily muscled up in the shoulder girdle and neck areas as their male counterparts. Therefore, their head is not as firmly anchored to the shoulders, which makes it easier for the head to move when struck by a blow,” Dr. Batjer says, adding that children also are more susceptible to concussions because they have thinner and weaker necks compared with fully grown adults. “They don’t have the absorption capability that a mature male professional athlete would have.”
4. A Woman’s Hormones May Affect Her Health Outcomes Following a Concussion
Changes in estrogen and progesterone levels, especially during a menstrual cycle, can lead to poorer outcomes in women who receive concussions. A study published in 2014 in the Journal of Head Trauma Rehabilitation found that the menstrual cycle can have a negative influence on a woman’s concussion symptoms following her injury. Researchers analyzed 144 women with concussions in six emergency departments to determine their neurologic outcomes and quality of life one month post injury. A blood test that measured progesterone levels was used to determine each woman’s stage of the menstrual cycle. Researchers found that women who were injured during the last two weeks of the menstrual cycle — when progesterone was at its highest (luteal phase) — had worse post-concussion symptoms compared with women injured during the first two weeks — when progesterone was low (follicular phase) — and with those who were taking contraceptive pills. The levels of sex hormones, such as progesterone, which is known to have a calming effect and can improve cognition, memory, and mood, can change after a concussion, too. When women receive a blow to the head during the luteal phase, progesterone production slows to create a sense of withdrawal, making concussion symptoms, such as headache, dizziness, and nausea, worse. This is known as the “withdrawal hypothesis,” a term coined by Jeffrey Bazarian, MD, MPH, lead author of the study and professor of emergency medicine and neurology at the University of Rochester Medical Center in New York. “Is the progesterone causing all the problems in concussion? No, but it’s probably taking the problems from a typical concussion and making them worse,” he says. Angela Colantonio, PhD, professor and director of the Rehabilitation Sciences Institute at the University of Toronto in Canada, conducted a study, published in the Journal of Women’s Health, to see if menstrual functioning, fertility, and pregnancies were affected after a woman receives a TBI. She and her colleagues found that 68 percent of the 104 observed women experienced irregular menstrual cycles after their injury as well as lower mental health and function. “I can’t really say the exact mechanisms on why that occurs, but they do occur,” Dr. Colantonio says. “It needs to be further researched for the exact cause.”
5. Women Are More Likely to Report Their Symptoms Than Men
The higher rate of TBIs in women may have to do with the fact that women are more likely to report a head injury or correlating symptoms than men, studies have found. Covassin says that men typically hide their symptoms in order to not let their coaches or teams down. She also says that men have more opportunities to play in a professional setting, so they don’t want to put their career on the line for the sake of a head injury. “Males will not completely be honest and report those injuries because they do have a chance to go pro sport. Females, on the other hand, even if we go pro sport, we really don’t make any money,” she says. “For us, it’s not about going pro and making millions of dollars.”
The Need for More Sex-Specific Studies on Concussions
Batjer says that our culture has made strides in how we treat concussions and other TBIs, but it’s important to study the long-term effects of these injuries in order to know how to treat each sex differently. “The awareness has really changed the landscape and TBIs are the signature injury of the 21st century,” he says. “I think recognizing that there is a difference in how women and girls react to concussive injuries is important, and allowing full recovery is going to favorably impact long-term outcomes of these athletes. We have to focus on the rest of their lives and healthy aging.”
