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 advised that I had migraines and I’d ‘recover from them’ and that I used to be ‘complaining an excessive amount of’ – feedback which might be sadly all too frequent for girls to listen to,” she says.
“After 6 years, I noticed an optometrist who seen 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 indignant that her complications had been minimized and her visible points ignored. “I had 20/20 imaginative and prescient, so it didn’t happen to anybody that I might be having eye issues,” she says.
‘Invisible’ and Uncared for
Katherine Snedaker, a licensed scientific social employee, agrees that girls’s concussions are sometimes minimized or ignored. She created and leads PINK Concussions, a nonprofit group centered on concussions in ladies.
She says nearly all the earlier concussion analysis has used male lab animals and males as topics, though concussions are frequent in ladies too. And whereas folks consider concussions in ladies 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 in a position to elevate 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 ladies that suffer intimate accomplice violence in each social and financial group of society,” she says.
“Concussions have an effect on ladies and men otherwise, so it’s essential 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 automotive accidents.
Hormonal Connection?
David Wang, MD, head workforce physician at Quinnipiac College in Hamden, CT, says that when ladies and men compete in the identical sports activities, ladies 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 ladies are extra susceptible to concussions and sometimes 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 could play a task. For instance, one research discovered that girls at sure phases of their menstrual cycle had worse signs after their concussion. And girls 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 elements of girls’s hormones. Stress to the pituitary – whether or not as a result of mechanical harm of the concussion or to emotional stress that may comply with a concussion – could have an effect on the menstrual cycle.”
That is supported by a brand new research. The researchers screened for hypopituitarism (low hormonal manufacturing by the pituitary) in 133 feminine athletes with a historical past of traumatic mind harm. The researchers discovered that almost all of girls (66.2%) had irregular pituitary screening blood check 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 ladies’s vulnerability to concussions.
“Girls on the whole have weaker necks; and for the reason that neck is weaker, the top accelerates extra when it’s hit as a result of the affect 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 ladies have weaker necks, in comparison with males, their eye actions are going to be extra susceptible to neck-related accidents.”
She says eye issues are additionally a little-known complication of whiplash as effectively. “The connection is within the brainstem and the neck.”
She says that the neck could not essentially be painful, however eye ache or complications could be “referred” ache from the neck.
Different theories embody that girls additionally could have completely 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 best and left hemispheres. “This space receives nearly all of the pressure from a concussive blow, and that space is extra robustly utilized by ladies 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 in regards to the better frequency of concussions in ladies and their extra extreme signs.
“Some folks assume ladies 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 at the least as doubtless as males to cover signs in order to not be taken out of the sport. “The truth is, a number of the most pushed folks I’ve ever met are feminine athletes,” he says.
Snedaker recommends that girls take their signs critically. “I’ve spoken to numerous ladies who mentioned their concussion signs had been dismissed by docs or had been advised that they’re merely anxious.” she says.
So should 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 distinct supplier,” Snedaker advises.
Totally different Signs, Totally different Therapies?
Many of the signs of concussion – aside from menstrual dysfunction – don’t differ between the sexes, based on Wang. “It’s not like a coronary heart assault, the place typically, ladies even have completely different signs than males – like nausea relatively than chest or jaw ache,” he says.
Typical signs of concussion in each women and men embody complications, dizziness, blurry imaginative and prescient or different visible disturbances, agitation or cognitive adjustments, mild 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 ladies who’ve had a concussion about their durations. “If there’s a problem, comply with up with endocrine testing,” she recommends. And should you’ve had a concussion and spot adjustments in your durations, make sure you convey this as much as your supplier.
Women and men have comparable “landmarks” and “guidelines” for returning to play or to every other exercise, reminiscent of employment or lecturers. “We anticipate them to be with out signs, and we put them by way of a graded return to exercise,” Wang states.
However since ladies’s signs are likely to last more than these of males, “ladies have to be supported all through that point,” Snedaker emphasizes. All too typically “ladies are referred to as ‘malingering’ or ‘mentally in poor health’ after they don’t get better as quick as males.”
