FEMALE BRAIN INJURY


What are the differences between males and females in terms of concussion frequency, severity, symptoms, outcomes, etc.?

Scientific research has shown that female and male brains differ in more than 100 ways in structure, activity, chemistry, and blood flow, and so it is logical that damage to the brain would also manifest differently in women and men. However, brain injury research including sport concussion research has long been viewed through a masculine perspective partly due to the findings that TBI in general occurs about twice as often in males as it does in females (Rao & Lyketsos, 2000). 

The riskiest sports for concussion often have being male-dominated (i.e. collision/contact sports such as ice hockey, boxing/combat sports, football, rugby). However, multiple research studies have found in sports with similar rules between females and males, in particular soccer, basketball and baseball/softball, the rates of concussion are actually higher in women (Gessel, Fields, Collins, Dick, & Comstock, 2007; Hootman, Dick, & Agel, 2007; A E Lincoln et al., 2012).

In the 2012 American Medical Society for Sports Medicine Position Statement: Concussion in Sport, research showed that in sports with similar rules female athletes sustain more concussions than their male counterparts. In addition, female athletes experience or report a higher number and severity of symptoms as well as a longer duration of recovery than male athletes in several studies.

From American Medical Society for Sports Medicine Position Statement: Concussion in Sport 2012

  • Recent data suggest that in sports with similar rules female athletes sustain more concussions than their male counterparts.
  • In addition, female athletes experience or report a higher number and severity of symptoms as well as a longer duration of recovery than male athletes in several studies.

What are the proposed reasons for these differences?

Female athletes may be at a greater risk for concussion due to what phase they are in in their monthly hormones at the time of injury, an increase in angular acceleration at the neck, or neck strength-to-head size ratios. There is some research which shows that female athletes are more likely to report their injuries in compared to men, but these studies fail to highlight how often female athletes hid their concussions.


Is there any influence of gender roles/expectations, for example that boys are tougher than girls, so perhaps expected to return to activities more quickly, or less likely to seek treatment or some such?

It is important to understand the difference between sex and gender.

  • Definition of Sex Scientifically, sex may be defined as the biological differences between male and female, including genetic, hormonal and physiological differences. Sex differences in female to male brain injury are would be hormone levels or neck strength vs. size of head. 
  • Definition of Gender Gender is thought of as a social construct based upon interpersonal roles or personal identification and is often but not always concordant with biological sex.  Gender differences  are those such as the very controversial explanation that women more likely to report injuries or female culture of seeking health care. What is coming more and more to the surface recently is "Test bias" in how research studies are designed, and how studies are conducted, and how results are interrupted which also may play a role in differences seen between males and females, especially in sport concussion research.

Gender differences  are those such as the very controversial explanation that women more likely to report injuries or female culture of seeking health care. What is coming more and more to the surface recently is "Test bias" in how research studies are designed, and how studies are conducted, and how results are interrupted which also may play a role in differences seen between males and females, especially in sport concussion research.


What are the clinical implications of these findings?

While research shows females may have different injury rates, symptoms, and rates of recovery, the medical community does not yet have any female-specific guidelines, protocols, care plans or education resources for women with brain injury including concussions. Since more men than women have brain injury, a woman and the people around her will most likely know more men than women who have had concussions and could judge her symptom pattern and length of recovery by the male experience.

The patient may doubt herself when the speed of her recovery or the severity of her symptoms do not match the male experience she knows. Family members, school staff or employers as judge her experience to be abnormal, malingering or view there maybe other non-brain injury issues at play. Without proper education of patient, family and community supports, women and girls with brain injury including concussion, can experience an additional lack of support, doubt, isolation and anxiety beyond that which comes with brain injury.