March 14, 2023 – Jacqueline Theis, a Virginia-based optometrist, was an avid soccer participant throughout her teenagers. In the midst of her athletic profession, she had a number of concussions that triggered extreme complications when she tried to learn.
“I used to be informed that I had migraines and I’d ‘recover from them’ and that I used to be ‘complaining an excessive amount of’ – feedback which are sadly all too frequent for ladies to listen to,” she says.
“After 6 years, I noticed an optometrist who observed that my eyes weren’t coordinating and thought this was as a result of concussions,” she recounts. “She prescribed glasses and imaginative and prescient remedy, and my complications went away.”
Theis was offended that her complications had been minimized and her visible points neglected. “I had 20/20 imaginative and prescient, so it didn’t happen to anybody that I could possibly be having eye issues,” she says.
‘Invisible’ and Uncared for
Katherine Snedaker, a licensed medical social employee, agrees that girls’s concussions are sometimes minimized or neglected. She created and leads PINK Concussions, a nonprofit group targeted on concussions in girls.
She says virtually all the earlier concussion analysis has used male lab animals and males as topics, though concussions are frequent in girls too. And whereas individuals consider concussions in girls as being sports-related accidents, PINK Concussions’ mission contains shining a highlight on accidents, navy service accidents, and home violence.
Over the previous 5 years, “we’ve been capable of increase consciousness of mind accidents in feminine athletes and girls veterans, however the far better variety of repetitive mind accidents are nonetheless hidden and endured by the invisible girls that suffer intimate companion violence in each social and financial group of society,” she says.
“Concussions have an effect on men and women in a different way, so it’s vital for clinicians, mother and father, and others to pay attention to how concussions would possibly current in females in addition to males,” says Snedaker, who has had a number of concussions, two of which got here from automobile accidents.
David Wang, MD, head group physician at Quinnipiac College in Hamden, CT, says that when men and women compete in the identical sports activities, girls get concussions at larger charges than males. Their signs additionally are usually extra extreme, and so they typically have extra extended signs.
There are a number of theories as to why girls are extra weak to concussions and infrequently have extra extreme signs or poorer outcomes, says Wang, who’s the director of Complete Sports activities Drugs in Connecticut.
Some research counsel that feminine hormones might play a job. For instance, one examine discovered that girls at sure phases of their menstrual cycle had worse signs after their concussion. And ladies typically discover adjustments of their menstrual patterns after a concussion.
However Wang believes the story is extra advanced. “Concussions shake the pituitary gland, which is positioned within the head,” he says. “The pituitary is answerable for regulating facets of girls’s hormones. Stress to the pituitary – whether or not as a result of mechanical damage of the concussion or to emotional stress that may comply with a concussion – might have an effect on the menstrual cycle.”
That is supported by a brand new examine. The researchers screened for hypopituitarism (low hormonal manufacturing by the pituitary) in 133 feminine athletes with a historical past of traumatic mind damage. The researchers discovered that almost all of girls (66.2%) had irregular pituitary screening blood take a look at outcomes. Sure hormones had been too excessive, whereas others that had been too low. Youthful athletes and people with extra signs had extra pituitary hormone abnormalities.
Neck, Eyes, and Mind
Wang shared a number of different theories concerning girls’s vulnerability to concussions.
“Girls typically have weaker necks; and for the reason that neck is weaker, the top accelerates extra when it’s hit as a result of the influence is extra extreme and violent,” he explains. Though this “isn’t the entire story, it’s a contributing issue.”
Theis, who’s affiliated with the Concussion Care Centre of Virginia, says there’s an “intimate relationship between eye actions, the brainstem, and the neck; and since girls have weaker necks, in comparison with males, their eye actions are going to be extra weak to neck-related accidents.”
She says eye issues are additionally a little-known complication of whiplash as nicely. “The connection is within the brainstem and the neck.”
She says that the neck might not essentially be painful, however eye ache or complications might be “referred” ache from the neck.
Different theories embrace that girls additionally might have totally different ranges of irritation, in comparison with males, Wang says. And concussions typically goal an space of the mind referred to as the corpus callosum, which connects the precise and left hemispheres. “This space receives nearly all of the pressure from a concussive blow, and that space is extra robustly utilized by girls than by males as a result of females have a tendency to make use of each hemispheres in course of greater than males do.”
Myths About Girls
All of the specialists agree that there are frequent myths concerning the better frequency of concussions in girls and their extra extreme signs.
“Some individuals suppose girls have extra concussions as a result of they complain extra about signs, so that they’re extra prone to be recognized,” Wang says. “I don’t like to listen to that, as a result of it suggests that girls are ‘complainers’ and likewise that feminine athletes are much less aggressive than male athletes, which merely isn’t true.”
Wang and his colleagues studied athletes and located that females had been a minimum of as probably as males to cover signs in order to not be taken out of the sport. “In truth, among the most pushed individuals I’ve ever met are feminine athletes,” he says.
Snedaker recommends that girls take their signs significantly. “I’ve spoken to numerous girls who mentioned their concussion signs had been dismissed by docs or had been informed that they’re merely anxious.” she says.
So in case you’ve had a blow to the top and your well being care supplier doesn’t do an intensive concussion workup, “it’s time to search for a unique supplier,” Snedaker advises.
Totally different Signs, Totally different Therapies?
Many of the signs of concussion – apart from menstrual dysfunction – don’t differ between the sexes, in response to Wang. “It’s not like a coronary heart assault, the place typically, girls even have totally different signs than males – like nausea quite than chest or jaw ache,” he says.
Typical signs of concussion in each women and men embrace complications, dizziness, blurry imaginative and prescient or different visible disturbances, agitation or cognitive adjustments, gentle and sound sensitivity, disorientation, nausea or vomiting, or feeling dazed.
As a result of concussions can have an effect on the menstrual cycle, Snedaker encourages well being care professionals to ask girls who’ve had a concussion about their intervals. “If there’s a problem, comply with up with endocrine testing,” she recommends. And in case you’ve had a concussion and see adjustments in your intervals, make sure you carry this as much as your supplier.
Women and men have comparable “landmarks” and “guidelines” for returning to play or to some other exercise, akin to employment or teachers. “We anticipate them to be with out signs, and we put them via a graded return to exercise,” Wang states.
However since girls’s signs are inclined to last more than these of males, “girls must be supported all through that point,” Snedaker emphasizes. All too typically “girls are referred to as ‘malingering’ or ‘mentally ailing’ after they don’t get better as quick as males.”