Wednesday, January 12, 2011

Concussion Symptoms Can Vary Between Males and Females

A recent survey of high school sports reported that concussions accounted for around 9% of all injuries. Concussion rates are generally highest in contact sports such as American football. Despite soccer being considered a non-contact sport, head injuries are also fairly common. It is estimated that 6-7% of all US high school players suffer a concussion every year. Diagnosis of a concussion can often be difficult. Unless there is a loss of consciousness, diagnosis depends on the patients reporting of symptoms. What makes matters more difficult is that that symptoms can vary from one athlete to the next, especially in terms of severity. A new study emphasizes the variety of symptoms associated with a concussion. It further shows that male and female athletes may show different concussion symptoms.

The study, conducted over a two year period, focused on US high school athletes. Athletic trainers from 100 schools entered concussion information into an on-line database – High School Sport-Related Injury Surveillance System. Each time an athlete was diagnosed with a concussion, information such as gender, type and number of symptoms, symptom resolution time, and return to play time were entered into the database.

A total of 812 concussions were recorded. Males accounted for about 75% of the concussions and females, 25%. The most often reported symptom was headache, the hallmark symptom of a concussion. More than 95% of both men and women reported headache. Dizziness was also reported by about 77% of both males and females. Most athletes (71%) reported that their symptoms had resolved within 3 days although ~10% reported that they lasted from more than a week.

There were some key differences in the symptoms reported by the men and women. Males more often reported amnesia (memory loss) and confusion / disorientation than did the female athletes. Whereas, females were more likely to report feelings of drowsiness and sensitivity to noise than were the males. This is the key finding of the study – the different symptoms experienced by the two genders.

Some researchers classify concussion symptoms into three categories. The first is “cognitive” and includes symptoms such as lack of concentration or focus, feeling “in a fog” and loss of memory. Second is “neurobehavioural” which includes signs such as sleepiness, fatigue and anxiety. Last is “somatic” which is described by headaches, nausea, light / noise sensitivity and balance problems. Based on the current study, men tend to suffer more from cognitive issues (amnesia and confusion). Women, on the other hand, tend to suffer from neurobehavioral (drowsiness) and somatic (sensitivity to noise) problems. Unfortunately, these neurobehavioral and somatic symptoms can often be overlooked and attributed to other conditions such as stress or anxiety rather than concussion.

An earlier study emphasizing the need to monitor the neurobehavioral symptoms of a concussion was discussed on the Science of Soccer Online (link). The authors of that study pointed out that feelings of fatigue and lethargy can often be overlooked as a symptom and can persist for several weeks, even after the athlete has been medically cleared to play.

It is important to realize that cognitive symptoms are generally perceived as more obvious limitations to play. If the athlete appears confused or has a loss of memory, it is more apparent that he or she will have difficulty competing. The same could be said for somatic symptoms such as headache. However, neurobehavioral symptoms may be perceived as less likely to affect play. Tiredness and fatigue are something that many athletes deal with on a daily basis. Thus, the neurobehavioral concussion symptoms displayed by some female athletes may be overlooked and full recovery from a head injury could be misdiagnosed. Prolonged feelings of tiredness, drowsiness, lethargy and fatigue may be signs that the athlete is not ready to return to the field.

The take home message of this study is that the symptoms of a concussion may differ between men and women. Women may suffer from neurobehavioral symptoms such as drowsiness and fatigue that may not appear in men. Coaches and trainers should be aware that concussions are a complex injury and all symptoms, cognitive, neurobehavioral and somatic should be evaluated when determining if an athlete is ready to compete.


Frommer LJ, Gurka KK, Cross KM, Ingersoll CD, Comstock RD, Saliba SA (2011) Sex differences in concussion symptoms of high school athletes. Journal of Athletic Training, 46:76-84.