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 can be sadly all too widespread 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 because of the 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 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 centered on concussions in ladies.
She says nearly the entire earlier concussion analysis has used male lab animals and males as topics, though concussions are widespread 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 capable of elevate consciousness of mind accidents in feminine athletes and girls veterans, however the far larger variety of repetitive mind accidents are nonetheless hidden and endured by the invisible ladies who are suffering intimate associate violence in each social and financial group of society,” she says.
“Concussions have an effect on ladies and men in a different way, so it’s vital for clinicians, dad and mom, 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.
David Wang, MD, head crew 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, they usually usually have extra extended signs.
There are a number of theories as to why ladies 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 recommend that feminine hormones could play a job. For instance, one examine discovered that girls at sure phases of their menstrual cycle had worse signs after their concussion. And girls usually discover modifications 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 chargeable for regulating facets of ladies’s hormones. Stress to the pituitary – whether or not because of the 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 examine. 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 ladies (66.2%) had irregular pituitary screening blood take a look at outcomes. Sure hormones have been too excessive, whereas others that have 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 relating to ladies’s vulnerability to concussions.
“Ladies typically have weaker necks; and because the 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 weak 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 may 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 usually 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 Ladies
All of the consultants agree that there are widespread myths in regards to the larger 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 identified,” 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 have been a minimum of as possible as males to cover signs in order to not be taken out of the sport. “In actual fact, among the most pushed folks I’ve ever met are feminine athletes,” he says.
Snedaker recommends that girls take their signs severely. “I’ve spoken to numerous ladies who mentioned their concussion signs have been dismissed by docs or have been advised that they’re merely anxious.” she says.
So for those who’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 special supplier,” Snedaker advises.
Completely different Signs, Completely different Therapies?
A lot of the signs of concussion – aside from menstrual dysfunction – don’t differ between the sexes, in line with Wang. “It’s not like a coronary heart assault, the place usually, ladies even have completely different signs than males – like nausea somewhat 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 modifications, 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 difficulty, comply with up with endocrine testing,” she recommends. And for those who’ve had a concussion and see modifications 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, resembling employment or lecturers. “We anticipate them to be with out signs, and we put them by a graded return to exercise,” Wang states.
However since ladies’s signs are inclined to last more than these of males, “ladies must be supported all through that point,” Snedaker emphasizes. All too usually “ladies are referred to as ‘malingering’ or ‘mentally sick’ after they don’t recuperate as quick as males.”