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Boys versus Girls: Concussions


Over the years, more information has been making the headlines regarding concussions. Symptoms can occur immediately or days later and include: headache/feeling of pressure in the head, dizziness, amnesia surrounding the event, temporary loss of consciousness, confusion/fogginess, nausea, vomiting, tinnitus (ringing in the ears), slurred speech, delayed response, depression, dazed appearance, difficulty concentrating, short term memory issues, irritability/personality changes, insomnia, taste/smell disorders, photophobia (sensitivity to light) or noise and fatigue. Football has increased the overall recognition of concussions, but there still remains limited research when it comes to females. Hoping to learn more information on treating all clientele, I attended a seminar in Washington, DC specifically focused on the female aspect of head injuries. The conference ended with a discussion panel held in the library of Georgetown University. Lectures of personal experience were given from women affected by concussions including a two time gold medal winner and Olympic goalie, various athletes (aged late teens to early twenties) and a couple from Canada; they had lost their 17 year old daughter, a rugby athlete, to Second Impact Syndrome (SIS). For more on their daughter’s story you can google Rowan's law.

Second Impact Syndrome is a second concussion sustained during the recovery stage which can result in a dangerous drop in blood flow and energy levels. The result of suffering more than one concussion in a short time period (between 1-2 weeks), can create rapid increased swelling in the brain causing death. The severity of SIS is eye opening; adolescent males and females are susceptible. This leads to the next question: Is there a difference amongst males and females when it comes to concussions? A quick answer would be is yes, and unfortunately females tend to be worse off.

-Females are more prone to concussions than males
-Females obtain concussions at a higher rate
-There is a higher severity of symptoms found in girls and women
-There are differences in subjective reported symptoms
-Females report more objective cognitive and visual signs/symptoms (balance issues/vision problems)
-Female patients had an average of 4.5 symptoms compared to 3.6 for males
-Females take longer to heal and recover
-Females experience longer lasting symptoms
-Females have more persistent post-concussion symptoms than males

-Females have weaker neck muscles
-Females have less neck girth and less head-neck segment stiffness in comparison to males
-Increased complications of the female brain (due to an overall increased amount of thoughts and emotions to males)
-Females heal less quickly when a concussion is sustained when progesterone levels are naturally high. (If a concussion during the premenstrual phase, an abrupt drop in progesterone after injury creates a withdrawal effect leading to or worsening of post concussive symptoms such as nausea, headache, dizziness and difficulty concentrating)
-Female brains are wired differently than males in response to the injury
-Females have different blood flow in the brain (higher blood flow compared to males)
-Females have less myelin sheathing around nerve fibers
-Females are often predisposed to migraine headaches

Prevention/What to do

-Know the risks
-Make sure you fully heal before being exposed to future risks/return to sports
-Suspect a concussion? Get examined by a medical professional
-Wear a helmet when needed (Female concussions are most common in soccer. Lacrosse headgear is optional at this time)
-Wear a seatbelt
-Improve your balance
-Strengthen your neck muscles

Future Questions
It has not been yet proven if women are also more vulnerable to chronic traumatic encephalopathy (CTE). CTE is a neurodegenerative condition that may be linked to concussions leading to confusion, memory loss, and long-term conditions such as dementia and depression. CTE causes brain tissue to progressively degenerate leading to a buildup of abnormal proteins called tau. Multiple concussions have been linked to the risk of CTE, but the condition cannot yet be diagnosed on a living a person. Currently Boston University maintains a bank of donated brains to further research and study. Of the multiple male donated brains, researchers have found elevated levels of the tau protein in the cerebrospinal fluid (CSF) of more than half of former professional athletes who experienced multiple concussions. More female athlete brain donations are required in order to further research this area.

Future Testing
As we know MRI and CAT scans are unable to detect concussions; although they show bleeding in the brain in severe cases.
Tau is further being tested and researched if it can be found in blood, saliva, sweat, and CSF; however tau may or may not always be present despite a concussion or CTE.

Treatment often requires rest physically and mentally, refraining from electronic screen time and tasks that include higher levels of concentration. Research offers differing viewpoints as to how long a patient should refrain from physical activity and classwork. Due to symptoms of depression, often some form of physical activity such as walking is recommended. Unfortunately some treatments may increase symptoms slightly before improvement. A team approach is now being implemented for the treatment of concussions and often includes physical therapy, primary care physicians, neuropsychologists, behavioral neuro optometry, vestibular training and communication among teachers, parents, and coaches when necessary.


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