March 14, 2023 — Jacqueline Theis, a Virginia-based optometrist, was an avid football player during her teenage years. During her athletic career, she had several concussions which triggered severe headaches when she tried to read.
“I was told I had migraines and would ‘get over it’ and ‘complain too much’ – comments women unfortunately hear all too often,” she says.
“After 6 years, I saw an optometrist who noticed that my eyes weren’t coordinating and thought it was due to concussions,” she says. “She prescribed me glasses and vision therapy, and my headaches went away.”
Theis was angry that her headaches had been minimized and her vision problems overlooked. “I had 20/20 vision, so it hadn’t occurred to anyone that I might have eye problems,” she says.
“Invisible” and overlooked
Katherine Snedaker, a licensed clinical social worker, agrees that concussions in women are often minimized or overlooked. She created and runs PINK Concussions, a non-profit group focused on concussions in women.
She says almost all previous research on concussions has used both male and male laboratory animals as subjects, although concussions are also common in women. And while people think concussions in women are sports-related injuries, PINK Concussions’ mission is to shine a light on accidents, military service injuries and domestic violence.
Over the past 5 years, “we have been able to educate female athletes and female veterans about brain injury, but the far greater number of repetitive brain injuries are still hidden and suffered by invisible women who experience intimate partner violence. in every social and economic group in society,” she says.
“Concussions affect women and men differently, so it’s important for clinicians, parents and others to be aware of how concussions can present in both women and men,” says Snedaker, who has had several concussions, two of which were due to car accidents. .
Hormonal connection?
David Wang, MD, team physician at Quinnipiac University in Hamden, CT, says that when women and men compete in the same sports, women experience concussions at higher rates than men. Their symptoms also tend to be more severe and they often have more prolonged symptoms.
There are several theories as to why women are more vulnerable to concussions and often have more severe symptoms or poorer outcomes, says Wang, director of Comprehensive Sports Medicine in Connecticut.
Some studies suggest that female hormones may play a role. For example, one study found that women in certain phases of their menstrual cycle had more severe symptoms after their concussion. And women often notice changes in their menstrual patterns after a concussion.
But Wang thinks the story is more complex. “Concussions shake the pituitary gland, which is located in the head,” he says. “The pituitary gland is responsible for regulating aspects of female hormones. Stress to the pituitary gland—whether from the mechanical injury of a concussion or the emotional stress that can follow a concussion—can affect the cycle menstrual.
This is supported by a new study. The researchers examined hypopituitarism (low hormone production by the pituitary gland) in 133 female athletes with a history of traumatic brain injury. The researchers found that the majority of the women (66.2%) had abnormal pituitary gland blood test results. Some hormones were too high, while others were too low. Younger athletes and those with more symptoms had more pituitary hormone abnormalities.
Neck, eyes and brain
Wang shared several other theories regarding women’s vulnerability to concussions.
“Women in general have weaker necks; and because the neck is weaker, the head accelerates more when struck because the impact is harder and more violent,” he explains. Although this “is not the whole story, it is a contributing factor”.
Theis, who is affiliated with the Concussion Care Center of Virginia, says there is an “intimate relationship between eye movements, the brainstem, and the neck; and since women have weaker necks than men, their eye movements will be more vulnerable to neck-related injuries.
She says eye problems are also a little-known complication of whiplash. “The connection is in the brainstem and the neck.”
She says the neck doesn’t have to be sore, but eye pain or headaches can be “referred” pain from the neck.
Other theories include that women may also have different levels of inflammation than men, Wang says. And concussions often target an area of the brain called the corpus callosum, which connects the right and left hemispheres. “This area receives the majority of the stress from a concussive blow, and this area is used more vigorously by women than by men because women tend to use both hemispheres more than men.”
Myths about women
All experts agree that there are common myths about the greater frequency of concussions in women and their more severe symptoms.
“Some people think that women have more concussions because they complain more about the symptoms, so they’re more likely to be diagnosed,” says Wang. “I don’t like to hear that because it suggests that women are ‘complainers’ and also that female athletes are less competitive than male athletes, which just isn’t true.”
Wang and his colleagues athletes studied and found that women were at least as likely as men to hide their symptoms so they wouldn’t be removed from the game. “In fact, some of the most motivated people I’ve ever met are female athletes,” says -he.
Snedaker recommends women take their symptoms seriously. “I’ve spoken to countless women who have said their concussion symptoms were ignored by doctors or told they were just anxious.” she says.
So if you’ve been hit in the head and your healthcare provider isn’t doing a thorough concussion exam, “it’s time to look for another provider,” Snedaker advises.
Different symptoms, different treatments?
Most concussion symptoms — other than menstrual dysfunction — do not differ between genders, according to Wang. “It’s not like a heart attack, where often women have different symptoms than men – like nausea rather than chest or jaw pain,” he says.
Typical symptoms of concussion in men and women include headache, dizziness, blurred vision or other visual disturbances, restlessness or cognitive changes, sensitivity to light and sound, disorientation, nausea or vomiting, or feeling lightheaded.
Because concussions can affect the menstrual cycle, Snedaker encourages medical professionals to ask women who have suffered a concussion about their periods. “If there’s a problem, follow up with endocrine testing,” she recommends. And if you’ve had a concussion and notice changes in your period, be sure to tell your provider.
Men and women have similar “markers” and “rules” for returning to play or any other activity, such as work or school. “We expect them to be symptom-free and subject them to a gradual return to activity,” says Wang.
But since women’s symptoms tend to last longer than men’s, “women need to be supported throughout this time,” Snedaker points out. Too often, “women are labeled as ‘faking’ or ‘mentally ill’ when they don’t recover as quickly as men. »
