Should we manage male and female concussions differently? Is it that simple?

It is no new information that male and female brains are different. There is plenty of evidence in the literature identifying those differences in male and female brains. It is also fact that there are differences in their rate of injury and rate of recovery, so why don’t we treat them differently? Here is a review to recent articles and studies reviewed by Dr. Esopenko shedding some light to the controversial subject.

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Males and Females brains are different, so why are we not managing their concussions differently?

Carrie Esopenko, PhD

A key aspect of concussion management is the proper assessment and treatment of the injury. We have long known that there are sex-specific differences in brain development and function, and we now know that there are sex-specific differences in how the brain responds to injury. This means that males and females are affected differently by concussion exposure and experience. In their review, Covassin and colleagues (2013) discuss a number of studies highlighting the differences in concussion prevalence (or number) and reported symptoms in male and female athletes. For example, female athletes report a greater number postconcussion symptoms (e.g., concentration problems, fatigue) and these symptoms tend to take longer to resolve as compared to male athletes (Broshek et al., 2005; Covassin et al., 2012). Studies have also shown that male and female athletes perform differently on cognitive tests following concussion (see Covassin et al., 2013 for a review). For instance, female athletes tend to demonstrate more difficulties on tasks assessing visual memory and reaction time following a concussion as compared to male athletes (Broshek et al., 2005; Covassin et al., 2012; 2013; Colvin et al., 2009), although it should be noted that some follow-up studies have failed to replicate these sex-specific differences (see Zuckerman et al., 2012).  It is thought that the functional differences between male and female athletes following concussion could be due to sex hormones, neuroanatomy, and blood flow in the brain (see Covassin et al., 2013 for a review). Given these noted differences, it makes sense to develop concussion management strategies that are sex-specific. However, because of the lack in understanding and research into differences in reported symptoms, functional abilities, and recovery for males and females following concussion, concussion management techniques are not currently tailored to the male and female brain. As concussion management specialists, we should be developing assessment and rehabilitation strategies that are tailored to issues specific to males and females. If we are able to accomplish this, I predict that this would lead to more sensitive assessment techniques for males and females, as well as better management of these injuries.

See full study by Covassin and colleagues for a review of sex-differences in the concussion management for male and female athletes:

Covassin, T., Elbin, R. J., Crutcher, B., & Burkhart, S. (2013). The management of sport-related concussion: Considerations for Male and Female Athletes.  Translational Stroke Research, 4, 420-424.

Other interesting studies on sex differences and concussion outcomes:

Broshek DK, et al. (2005). Sex differences in outcome following sports related concussion. J Neurosurgery, 102(5), 856–63.

Covassin, T., Elbin, R. J,, Harris, W., Parker, T., & Kontos A. (2012). The role of age and sex in symptoms, neurocognitive performance, and postural stability in athletes after concussion. Am J Sports Med,40(6), 1303-12.

Colvin, A. C., Mullen, J., Lovell, M. R. West, R. V., Collins, M. W., & Groh, M. (2009). The Role of Concussion History and Gender in Recovery From Soccer-Related Concussion. Am J Sports Med37(9), 1699-1704.

Zuckerman, S. L., Solomon, G. S., Forbes, J. A., Haase, R. F., Sills, A. K., & Lovell, M. R. (2012). Response to acute concussive injury in soccer players: Is gender a modifying factor? Journal of Neurosurg Pediatrics,10, 504–510. 

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