Why are concussions worse in females?

Women have been increasing in numbers in participation in all of sport. Women’s soccer, basketball, lacrosse and many other contact sports are seeing increasing number of participants of all ages. When looking at data comparing male versus female concussion injury rates in sports where both sexes play the same sport, females clearly predominate. In line with this rise in participation, many more pre-adolescent and adolescent athletes have been participating more in the sport of competitive cheerleading—an activity that has become more akin to gymnastics than traditional cheerleading. Injuries in this sport are demonstrating some of the susceptibility of women to concussion as there is a bigger pool of women competing in this sport than are men, demonstrating definitively higher concussive injury rates. We do not know why women are more susceptible to concussion than men. Just like the frequency of a greater amount of ACL injuries in women as compared to men, we believe the reason is probably multi-factorial. There are many theories for this susceptibility.

• One anatomical reason may be differing of the musculature in the cervical spine between men and women with the neck muscles being usually less developed in women than men. The head is also usually smaller in women than in men.
• The second may be due to the hormonal cycle and a potential effect on female athletes with concussion.
• The third may be due to differences in core strength between men and women. For now, we are not sure of the exact mechanism and investigations are currently taking place to answer these questions.

Differences may not be just anatomical. Some authors have postulated that female athletes are more likely to self-report symptoms than their male counterparts. This could be due to greater insight into the importance of recognizing and treating a concussion. Other authors have also reported that our healthcare system gives more attention to concussed female athletes than males due to female predominance and greater symptomatology in suffering from concussions, resulting in more diagnoses of concussion in the female population. We do know that when women are concussed that there are differences between the sexes. Women seem to have more significant symptoms than men. The symptoms also seem to last longer in women than men. Younger women also seem to fare worse than older women. This goes along with the understanding in concussion management that at least for now, the younger the patient who is concussed, the worse are the symptoms.