Post-Concussion Dizziness: An Integrated Approach to Treatment and Recovery
Concussion injuries can trigger a multitude of symptoms, each unique and complex in its own right. The severity of these symptoms can vary considerably, ranging from barely noticeable to exceptionally…
Short answer? Yes. As research advances, we are gradually starting to learn and understand that concussions affect women differently than men.
In the past, much of the research in the concussion space has centred on male athletes in contact sports – largely excluding women. Fortunately, much progress has recently been made in this space and more research is beginning to focus on women.
So, what are the differences between men and women when it comes to concussions?
Symptom differences at baseline
Throughout the research literature, girls consistently have a higher concussion symptom severity scores at baseline (i.e., when healthy). Although it seems as though the differences are mostly in certain symptom clusters in certain age groups (Moser et al., 2018)1:
10 – 12-year-olds: Total symptom scores for each sex were the same, meaning no differences were found.
12 – 17-year-olds: Here, the symptom score gap widens as it peaks, with girls’ scores spiking higher than boys’ scores.
18 – 22-year-olds: Symptom score gap remains the same, as symptom severity overall reduces for both sexes.
Many differences can also be seen when a closer look is taken at the symptom clusters:
Cognitive symptoms: When it comes to difficulties with concentration and memory for example, symptoms remain similar between the sexes, despite the age group.
Emotional symptoms: When it comes to symptoms such as sadness and anxiety, there is a large gap. Girls report emotional symptoms significantly higher than boys. This makes up for the bulk of the differences between baseline symptoms between the sexes.
Physical symptoms: Girls also report physical symptoms such as headaches and dizziness more often than boys, although the difference is less dramatic than emotional symptoms.
The emotional symptom cluster – an important component of concussion management – is the main factor in the difference between male and female concussion symptoms.
Another interesting finding is that despite girls reporting higher concussion symptoms, they tend to outperform boys on cognitive and physical tests during baseline (Combs et al., 2019)2. This includes balance, memory, concentration, delayed recall, reaction time and neurocognitive abilities.
Girls get more concussions than boys.
This is true across the board. In sports that are played by both sexes, girls consistently get more concussions.
In a recent study that looked at high school and college basketball, concussion ranked as the fourth highest injury for boys, and the second highest injury for girls (Clifton et al., 2018)3. Another systematic review found that women’s ice hockey, a non-contact sport, has more concussions than men’s ice hockey, which is a full contact sport (Prien 2018)4.
We don’t really know why this is, but there are a few theories:
The neck-to-head ratio is smaller for women than it is for men. Meaning, if women’s necks are thinner and weaker, they are less able to control their head when an impact happens. As a result, more force is delivered.
Hormonal differences and fluctuations with the menstrual cycle. Studies are mixed on this theory, however the theory is that during certain periods of elevated or lowered hormones, the brain may be more susceptible to injury.
Women are more likely to report symptoms. Rather than differences in concussions themselves, could there be a reporting bias? This is one of the leading theories surrounding the increased prevalence of concussions in women’s sports.
Despite the reasoning, we know for sure that women report more concussions than men.
Women also tend to take longer to recover from their concussion injuries. Middle-aged women specifically are more likely to suffer permanent symptoms from concussion.
Why? Another great question! Again, there are some theories:
Perhaps the injuries are more severe? If the neck is thinner and weaker, is more acceleration and force delivered to the head? If this theory holds true, perhaps women are suffering more severe injuries than men and therefore taking longer to fully heal.
Are women being more truthful about the fact that they are still experiencing symptoms? Are they taking more time to recover because they are being honest about not feeling 100 percent back to themselves?
Are hormonal differences and fluctuations around the menstrual cycle delaying symptoms or preventing recovery?
Are the high emotional symptoms (anxiety and depression) reported at baseline contributing to persistent concussion symptoms? We know that emotional symptoms are a major contributing factor to persistent concussion symptoms, regardless of what sex you are. Given the previous research we spoke about where women report higher emotional symptoms at baseline, is the prolonged recovery in women simply a reflection of higher emotional symptoms to begin with?
At this point in time, we don’t know for sure what the reasoning is – but we know what the results are, and that is that women take longer to recover from concussions.
Although there is room for a lot more research in this area, currently the concussion treatment approach to men and women is the same.
We don’t yet know a lot about long-term concussion consequences for women. What we do know, is that all of the brains which have been donated and studied so far, and all of the Chronic Traumatic Encephalopathy (CTE) literature to date, is on men!
CTE is the long-term neurodegenerative condition which has been attributed to concussions and repeated head trauma. This research in general is very early stage and we still have much to learn on the topic. We have even more to learn on how this affects women.
To hear more on this topic, check out this video from Ask Concussion Doc:
Moser RS, Olek L, Schatz P. Gender Differences in Symptom Reporting on Baseline Sport Concussion Testing Across the Youth Age Span. Archives of Clinical Neuropsychology. 2018;9:449.
Combs PR, Ford CB, Campbell KR, Carneiro KA, Mihalik JP. Influence of self-reported fatigue and sex on baseline concussion assessment scores. The Orthopaedic Journal of Sports Medicine. 2019;7(1):1-6.
Clifton DR, Onate JA, Hertel J, Pierpoint LA, Currie DW, Wasserman EB, et al. The First Decade of Web-Based Sports Injury Surveillance: Descriptive Epidemiology of Injuries in US High School Boys“ Basketball (2005–2006 Through 2013–2014) and National Collegiate Athletic Association Men”s Basketball (2004–2005 Through 2013–2014). Journal of Athletic Training. 2018;53(11):1025–36.
Prien A, Grafe A, Rössler R, Junge A, Verhagen E. Epidemiology of Head Injuries Focusing on Concussions in Team Contact Sports: A Systematic Review. Sports Medicine. 2018;48(4):953–69.
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