Study: Boys, Girls Suffer Different Concussion Symptoms

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The next time you see a girl soccer player yawning on the sidelines, don’t just assume she was up late the night before the game. She might have a serious concussion. According to a new study to be published in the January 2011 issue of the Journal of Athletic Training, girls and boys report different types of symptoms after suffering sports-related concussions. Researchers studied 812 reported concussions from 100 high schools across the nation and found that girls were more likely to suffer neurobehavioral and somatic symptoms, namely drowsiness and sensitivity to noise, than boys. Male high school athletes, on the other hand, were more likely to report cognitive symptoms, particularly amnesia and disorientation, than girls. (More on Little Kids Playing Sports. What’s So Wrong with That?)

These findings carry important consequences for both concussion management and diagnosis. “Some of the symptoms that girls seem more likely to suffer can be overlooked, especially in a hectic sideline situation,” notes Dawn Comstock, a research faculty member at the Center for Injury and Research Policy at Nationwide Children’s Hospital in Columbus, Ohio, and an author of the study.

If a female athlete appears drowsy, it’s easy to attribute that condition to a number of possible events. Perhaps she’s fatigued from running around the field, or from a late-night study session, or because she’s anxious and probably hasn’t gotten enough sleep. She can shake it off and get back in the game, right? If she’s showing sensitivity to noise, maybe it’s because the crowd, or the band, are too loud.

On the other hand, if an athlete were to start having cognitive issues like memory loss, coaches and athletic trainers would likely treat those symptoms much more seriously, and keep the player on the sidelines. From a female’s perspective, it might appear encouraging that girls are less likely to suffer scarier concussion symptoms like memory loss. But the most important step is to treat all symptoms equally, and keep a concussed athlete out of the game until a neurological pro gives a thumbs-up to return. Because all athletes, boys and girls, put themselves at serious risk while playing sports while already concussed. (More on Think Your Kid’s Physically Fit? Team Sports Don’t Offer Nearly Enough Exercise)

What explains these gender differences in concussion symptoms? “That’s the $54,000 question,” says Gerard Gioia, director of the Safe Concussion Outcome, Recovery, and Education Program at the Children’s National Medical Center in Washington, D.C. “Are there differences in brain response that can account for different symptoms? Does it have to do with hormones? The jury is still out.”

David Hovda, director of the Brain Injury Research Center at UCLA’s David Geffen School of Medicine, says differences in brain maturation — the region above the brainstem tends to mature faster in girls than in boys — could impact the symptoms.

Socio-cultural reasons might also be at play. Boys, raised to “man-up” and “get tough” while playing sports, might be more likely to hide symptoms like drowsiness and sensitivity to noise from their coaches and athletic trainers, thus accounting for the lower reported incidence; at the same time, it’s harder to hide memory loss. (More on Study: Fast-Food Ads Target Kids with Unhealthy Food, and It Works)

No matter the explanation, the message is clear. “Parents, coaches, and athletic trainers must understand all signs and symptoms of concussion,” says Comstock. “And as always, remember that when in doubt, sit them out.”

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