Women Are More Concussion-Prone than Men

Dr. Jones: There are many ways that women's brains are different from men's brains. But what about when brains get bonked like a concussion? Are they different? This is Dr. Kirtly Jones from Obstetrics and Gynecology from University of Utah Health, and this is The Scope.

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Dr. Jones: As a reproductive endocrinologist, I am interested in the sex differences in the brain and behavior between men and women. Sex differences are differences that are related to sex chromosomes and sex hormones. Of course, I'm also interested in gender differences. Gender differences are related to social and societal norms for behavior that are different between men and women.

When it comes to brain and behavior differences between men and women, there are sex and there are gender differences, and of course they're linked together in many but not all cases. For instance, the verbal part of the brain in women is generally comparatively bigger in women than men. We think that is probably related to hormones and early development, but we're not sure.

However, after babies are born, do moms talk to their baby girls differently than baby boys? That would be a gender difference. If women talk more than men on an average, is that a sex difference or a gender difference or a combination of the two? Women have significantly more migraines than men. We're pretty sure that this difference is largely hormonal, a sex difference and not gender, but it's complicated. Women are more likely to complain of headaches of any type than men are.

Okay, let's get to concussions. Men are more likely to have concussions than women. This may be related to the sports that are prone to concussive interactions: American football, hockey, boxing, you know. It may be related to the fact that men are more prone to risky behavior: cliff jumping, motorcycle riding.

Some of these are sex differences. If a women could get as big and as muscular as a defensive tackle, could she play high school or college football? Unfortunately, there are social situations in which women are much more prone to head injury than men such as domestic violence. So this makes it hard to study differences in closed head trauma in women and men. So if you pick a sport where the rules are the same for women and men and the sport engages a lot of women, then you can begin to study differences.

Soccer is a good case in point. In studies comparing concussion rates in soccer players, women have more concussions than men. Not a lot more, but a little more. Now we get to the interesting sex and gender issues. There are sex reasons why women might be more prone to concussion than men in soccer. Men have larger and more muscular necks so they can brace their head better, less snapping of the neck and shaking of the brain. Women may be slightly more likely to verbalize their symptoms after concussion, therefore they're more likely to be reported and counted. There is evidence that men are slightly less likely to report concussions. Studies show that both male and female athletes will lie about symptoms after head trauma to stay in the game, men about 79% of the time and women about 70% of the time. Actually, these numbers are really terrifying if athletes are so willing to cover up potentially dangerous symptoms.

Now, the hormone part is very interesting. One study of women who were hospitalized for concussion looked at women's hormonal status at the time of concussion. Women who were hurt in the early part of their menstrual cycle when there's just estrogen around, had on average longer times to recovery than women who were in the second half of their cycle or on birth control pills when progesterone or progestin hormones in the pill were around. This was added to some research in rats that suggested that rats that were given progesterone, a woman's hormone, immediately after head trauma, had less adverse brain effects. In the rat case, you can control for sex and gender, and the degree of head trauma.

This led to an early study of giving head trauma patients, both men and women, progesterone after head trauma to see if the brain was less damaged and recovered faster. The early studies suggested that progesterone was somewhat protective, and that was really exciting to me. Of course, most all of us are exposed to truly horrifying head trauma during a normal vaginal birth, but our brains are swimming in progesterone from our placenta so maybe that's protective. That aside, a larger randomized trial of progesterone treatment in head trauma didn't show a difference in outcome.

So what should we do about this? Of course, the National Brian Bank is looking for brains after death of men and women who've been exposed to concussions and is hoping for more brains. Of course, we're sad. We don't want people to die early, but if you do and your brain is useful, that would be something you could do. This bank has made news in their work on chronic traumatic encephalopathy, CTE, in the brains of athletes who died who were exposed to multiple concussions. To date the Bank in Boston University has detected CTE in 236 of 377 brains donated to the research lab. But only four of those brains belonged to women, and none of those women's brains had CTE.

There are more and more studies of women and concussion, and that's encouraging. There's a website and national non-profit organization called Pink Concussions to raise awareness of concussion in girls in women. Most importantly, if a girl or a woman has a head bonk and sees stars or has a temporary change in consciousness, not necessarily losing consciousness, she should stop what she's doing and be evaluated. Any sport that encourages using the head as a tool or a target: heading the ball in soccer, hitting the bead in boxing, should have the rules changed to protect men and women and boys and girls. And don't get me started on football.

To search The Scope website by putting concussion in the search box, you can learn more. Thanks.

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