High-level contact sports — including basketball, lacrosse, cheerleading, soccer and hockey — can put any athlete at greater risk of concussion. However, according to several studies, female athletes tend to be at increased risk compared to male athletes in certain sex-comparable sports - with females more likely to experience more post-concussion symptoms and potentially taking longer to recover.
Why Head Injuries Among Women Are More Common
Historically, scientists thought male athletes experienced more concussions than women. Why? Because men were more likely to participate in contact sports like football and hockey. But those assumptions have been turned upside down in recent years. Now, there's increasing awareness that women experience concussions more often than men in some sports with comparable rules (such as soccer and basketball) — and that a woman’s experience during a concussion may be different, too. Here are three potential reasons why:
- Neck strength: Athletes with weaker necks are at potentially greater risk for concussion. When your neck is weak, it’s harder to control your head if you get hit. "It’s more than an age or gender difference. It’s the muscle bulk involved in the task or activity," says Baibing Chen, M.D., a neurologist at Henry Ford Health. It just happens that, on average, female athletes tend to have smaller, thinner necks than males. However, neck strength (particularly extension strength) appears to matter more than neck size alone. Research shows that each 10% increase in neck extension strength is associated with a 13% reduction in concussion rate.
- Hormonal influences: The jury’s still out on whether hormones like estrogen affect the brain's response to injury (women have more estrogen than men). Emerging research suggests that progesterone levels and menstrual cycle phase may influence symptom severity and recovery, though findings remain inconsistent. Based on our understanding of the effects of hormones on brain function, fluctuations in hormone levels throughout a woman's menstrual cycle probably influence concussion risk and clinical presentation, says Dr. Chen.
- Symptoms: Concussion symptoms differ depending on how the brain was wired before the hit. "If someone has a propensity for migraine headaches, they're more likely to have a concussion with migraine-like symptoms, including headache and light and movement sensitivity," explains Dr. Chen. Since women tend to have more migraines than men (after puberty), they may be more likely to experience — and report — concussion symptoms. Female athletes do report more symptoms both at baseline and after concussion, and they are more likely to report symptoms to authority figures compared to males. But then the question becomes, are experts picking up more concussions among girls because they're better reporters?
How To Recognize A Concussion
Parents, coaches and players are increasingly recognizing that a hard hit can have serious consequences. But not every head injury is a concussion.
"When an athlete reports symptoms after a hit, it's important for trainers and medical professionals to consider all possible reasons for the symptoms," says Dr. Chen. "You want to make sure you're not assuming the athlete has a concussion, for example, when she's suffering from a migraine or neck injury. Of course, you also want to make sure you're not diagnosing only a concussion when an athlete has something much more serious, like a brain bleed."
A thorough baseline evaluation from a sports neurologist is an important benchmark to have when you're trying to diagnose or manage a concussion. Dr. Chen says athletes should get these evaluations annually, at the start of each season. They help trainers and medical staff determine if post-concussion brain changes are life altering or temporary.
Reviewed by Dr. Baibing Chen, a neurologist who sees patients at Henry Ford Hospital and Henry Ford Medical Centers in Plymouth and Taylor.
