Females are more likely to suffer a concussion compared to males, even in gender-matched sports like soccer. The likelihood of sustaining a concussion following an injury to the head or neck is 84% higher in female athletes compared to male athletes. Past research mainly focused on male subjects but a shift is occurring and differences in concussion symptoms between males and females are being revealed. Acknowledging gender differences in post-concussion symptoms is necessary to implement correct treatment protocols that are individualized and patient specific.
Symptom Severity
Multiple research studies found evidence that females experience more severe post-concussion symptoms and a higher number of symptoms compared to males. Females have a higher risk of developing headaches, dizziness, fatigue, irritability, light sensitivity, drowsiness, and concentration problems compared to males. Age and type of injury were taken into account so the differences were postulated to be attributed to gender differences. A study found that female athletes are 2.13 times more likely to report post-traumatic migraines compared to males.
Cognitive Function
Females tend to have worse cognitive functioning following a concussion compared to males, and they appear to perform less well on visual memory tasks. However, they tend to perform better on verbal memory tasks compared to males. In another study, females were 1.5 times more likely to have cognitive impairments after a concussion, and after adjusting for wearing protective equipment, they were more than twice as likely to have cognitive impairments following their injury. There is also some evidence that reaction time and responding speed are slower in females post-concussion compared to males.
When it comes to emotional aspects, male athletes were worse at identifying negative emotions compared to healthy male controls and concussed females. Concussed females were just as able to detect negative emotions as healthy female controls who have not endured a concussion.
Trajectory of Recovery
Females take longer to return to baseline following a concussion compared to males. Studies not only found that females endure a greater number and more severe symptoms, but they also take almost twice as long to recover. Across all recovery measures, females took longer to return to:
- Pre-injury functioning
- School without accommodations
- Non-contact exercise
- Sport performance
- Neurocognitive functioning
Sleep Disturbance
Females report significant sleep disturbance after sustaining one concussion whereas multiple concussions usually occur before males report sleep problems. Females with sleep disturbance tend to suffer from more headaches and mood changes. Additionally, cognitive deficits in females are more associated with sleep disturbance than among males. Sleep changes may therefore modulate recovery outcomes and explain the more severe post-concussive symptoms females experience.
Differences in Adolescents and Children
In addition to the more severe post-concussive symptoms and prolonged recovery period, concussions in girls are associated with worsened health-related quality of life compared to boys. They also report more anxiety, sadness, concerns related to cognitive performance, frustration, and negative attitude regarding recovery compared to their male counterparts.
Gender differences must be taken into account during rehabilitation and assessment of symptoms post-concussion. Awareness of the possible variability in symptoms is crucial for accurate diagnosis and treatment of concussions in both genders.
Written by Lea Farah
References
Clair, R., Levin Allen, S., Goodman, A., & McCloskey, G. (2020). Gender differences in quality of life and symptom expression during recovery from concussion. Applied Neuropsychology. Child, 9(3), 206-214. https://doi.org/10.1080/21622965.2018.1556102
Koerte, I. K., Schultz, V., Sydnor, V. J., Howell, D. R., Guenette, J. P., Dennis, E., Kochsiek, J., Kaufmann, D., Sollmann, N., Mondello, S., Shenton, M. E., & Lin, A. P. (2020). Sex‐Related differences in the effects of Sports‐Related concussion: A review. Journal of Neuroimaging, 30(4), 387-409. https://doi.org/10.1111/jon.12726
Oyegbile, T. O., Delasobera, B. E., & Zecavati, N. (2017). Gender differences in sleep symptoms after repeat concussions. Sleep Medicine, 40, 110-115. https://doi.org/10.1016/j.sleep.2017.09.026