6 minute read
CONCUSSIONS IN WOMEN
By Elizabeth MacGregor
Elizabeth MacGregor is a retired educator, guidance counsellor and head of guidance whose career was cut short by a concussion.
Advertisement
Twice as likely to suffer with recoveries hampered by a lack of clinical knowledge
Concussions can dramatically change a woman’s life. A less well-known fact is that women are twice as likely as men to suffer concussions and the effects are often more severe. They’re also almost twice as likely as males to show signs of cognitive impairment a few days after experiencing a concussion.
Not knowing these differences puts women at a huge risk of receiving inappropriate assessments, medical advice and care.
David Robson explored this in the January 31, 2020 issue of BBC Future: “Tracey Covassin, now based at Michigan State University, has been one of the leading researchers looking at potential sex differences in concussion. Canadian by birth, and inspired by her own love of ice hockey, when she first started out 20 years ago, she found next to no research on this subject. She noted a much larger decline in (female athlete) reaction times. Concussed female athletes also tend to show greater deficits in visual memory (though not every study has been able to detect this difference). Following a concussion, female athletes also seem to perform worse than males on a test of the vestibular-ocular reflex – which allows our eyes to fix on a target as our body moves.”
These athletes with vestibular-ocular reflex damage are at high risk of further concussions as they may not see an opponent who is approaching on their damaged side. Ms. Covassin also refers to a fogginess that can make them more prone to other kinds of accidents and falls.
Besides sports, people can be concussed from automobile accidents, falls, and domestic violence. These other causes of concussion also have a higher
level of occurrence among females and as Ms. Covassin saw in her athlete research, the symptoms are often more severe.
CUMULATIVE EFFECT
The number of concussions a person endures is often how neurologists assess damage and recovery prospects. Yet there is no single definitive test that tells a practitioner that, yes, this is a concussion. Rather, there are a series of examinations that indicate this is what has taken place. The changes can be subtle or major, concussions having so many potential symptoms – some mild, some serious, some showing up immediately, others coming later.
Symptoms vary from severe head pain, migraines, visual, auditory, speech, balance, memory, and emotional issues. Sufferers can have one or all symptoms. Males tend to experience amnesia while females are likely to have prolonged headaches, cognitive fatigue, and problems with mood regulation. Some researchers link this to there being more female than male migraine sufferers; however, migraines are not necessarily present in concussion sufferers.
IMPACT ON EVERYDAY LIFE
Concussions are a troubling condition that can have lifelong effects. Computer use and general reading can be impossible for those experiencing visual disturbances, leading to job and/or income loss. Balance problems can mean no driving. Anger, frustration, sadness can damage relationships. The onslaught of stimulation provided by modern life can leave a concussion sufferer sidelined and lonely, unable to cope with sounds, lights and movement. It is therefore imperative that this condition be properly diagnosed in a timely fashion, and effective therapy start immediately.
Pink Concussions is an online site, Facebook group and organization started by Katherine Snedaker, an American social worker, herself a concussion victim. The organization has been working to tease apart the differences between female and male concussion experiences.
One of the accomplishments of Ms. Snedaker was to encourage researchers all over the world to look at the issue of the female concussed brain and rid professionals of misinformation based on data that cannot be applied to female patients as only male brains have been studied after the deaths of athletes.
The findings of the researchers she has worked with point to neck differences in females versus males as well as hormonal differences. Neck strength to head size ratios differ dramatically, and it has been found that depending on the hormonal phase the female is in when concussed the outcome could be different.
There is also a “test bias” in research studies and how results are interpreted. It used to be thought that females simply reported concussions more often and that male athletes hid them. This has been proven to be untrue, with males and females hiding concussions at approximately the same rate.
NOT JUST AN ORDINARY HEADACHE
Women with headaches, or in tears, can be too easily dismissed as being just a common occurrence. This invisible condition can lead family members, or team members, to doubt the concussed athlete, and to insist on a premature return to play, ignoring the time needed for the brain to recover.
This situation can lead to a dire result. In 2013, Ontario high school rugby player Rowan Stringer died after ignoring her concussion symptoms. She suffered from second impact syndrome that causes
swelling in the brain. As a result, Rowan’s Law came into effect, requiring coaches to update their concussion knowledge and to pull athletes from play as soon as a concussion is suspected. Furthermore, a removal-from-sport and return-to-sport protocol must be established by all teams.
Dr. Charles Tator, a neurologist at Toronto Western Hospital and a leading concussion researcher in North America, has led the push in Canada to look into the differences in concussions between male and female athletes. His team has also led workshops to educate concussion sufferers, their caregivers, family doctors, lawyers and insurance adjusters, and conducts webinars to provide the most up-to-date information.
IMPROVING THE OUTCOMES
This medical team is aware of and informs on the differences between male and female concussion. However, the medical treatment of concussion and information shared with the patient may still lag behind current knowledge. It is then left up to patients and their families to search out up-to-date therapies and pursue alternatives. Recovery time can be wasted while the patient follows outdated, sometimes ineffective or dangerous advice.
The impact of concussion on the brain and the sufferer’s life can be devastating, and the fact that so many young athletes are severely impacted is frightening, for their parents, themselves, and their coaches.
I have witnessed a young female athlete slip into depression after a number of sports-related concussions, yelling at people, being miserable to deal with. She was suffering and no one really understood what she was going through. They just wanted her to play her sport.
After she graduated from the school where I met her, she returned to visit and was a different person. This sunny, happy young lady thanked me for being there for her when she was so difficult, and not turning my back on her.
With more brain research and better therapies offered we can hope to lessen the damage to these young brains and society.
RESOURCES
Pink Concussions https://www.pinkconcussions.com
The Ontario Brain Injury Association - OBIA http://obia.ca
The Ontario Neurotrauma Foundation - ONF https://onf.org
