Concussion Risks for Women

Concussions can affect anyone, but growing evidence from research show that female patients report more acute concussion symptoms and are at higher risk for a longer recovery period. A review of 156 studies found worse outcomes in women in about 60% of cases. These disparities are most pronounced in women of childbearing age. Women in this age group suffer greater cognitive declines, slower reaction times, more frequent headaches, longer bouts of depression, and longer return to work period after a concussion. Women who haven’t reached puberty or are post-menopausal show outcomes more similar to males, pointing to hormonal factors.

Women tend to take longer to recover from concussions, and researchers are exploring the biological, psychological, and sociocultural reasons why.

Several biological differences between sexes may contribute to women’s slower concussion recovery:

Neck and Body Strength: Women generally have smaller, less muscular necks than men. This provides less stability to the head during impact, allowing more whiplash motion. One analysis from the World economic forum noted that the average female neck circumference is ~30% smaller than a male’s, which can increase head acceleration by up to 50% under the same impact force. This results in a bigger relative impact on the brain . The greater the initial jolt to the brain, the more severe the injury can be and therefore longer the recovery.

Brain Physiology: Female brains tend to have a higher baseline blood flow and a faster metabolic rate than male brains, meaning the female brain requires more glucose and oxygen. A concussion disrupts normal blood flow and energy supply to brain tissue so the disturbance from a concussion causes greater ‘damage’. These physiological difference might help explain why the same trauma result in more intense or long lasting symptoms in women.

Hormonal Fluctuations: The influence of sex hormones like estrogen and progesterone is a major biological factor. Research suggests that the timing of a concussion within the menstrual cycle can affect outcomes. Women injured during the high-hormone luteal phase have significantly worse one-month outcomes than those injured during the low-hormone follicular phase. The world economic forum found that concussions in the premenstrual luteal phase led to more lingering symptoms a month later, whereas injuries in the follicular phase were less likely to have prolonged effects.

Other Medical Factors: Certain pre-existing conditions more common in women can prolong recovery. For example, a history of migraines is associated with protracted concussion recovery, and migraines are more prevalent in females.

Women’s longer concussion recovery times are likely due to an interplay of biological factors, psychological factors, and other factors not mentioned here. Biologically, a combination of physical differences and hormonal fluctuations can set the stage for a more difficult recovery. Psychologically, women often experience and report a heavier symptom burden. Recognizing these contributors is important to better support female athletes or patients. Greater awareness of sex differences in concussion outcomes can lead to improved, tailored care and rehabilitation strategies and drive more concussion research.