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 ignored. “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 ladies’s concussions are sometimes minimized or ignored. She created and leads PINK Concussions, a nonprofit group centered on concussions in ladies.
She says virtually all the earlier concussion analysis has used male lab animals and males as topics, though concussions are widespread in ladies too. And whereas individuals 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 ladies 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 necessary for clinicians, dad and mom, and others to concentrate on 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.
Hormonal Connection?
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 increased charges than males. Their signs additionally are usually extra extreme, and so they usually 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 studies suggest that feminine hormones might play a job. For instance, one research discovered that ladies at sure phases of their menstrual cycle had worse signs after their concussion. And ladies usually discover adjustments of their menstrual patterns after a concussion.
However Wang believes the story is extra complicated. “Concussions shake the pituitary gland, which is positioned within the head,” he says. “The pituitary is accountable for regulating elements of girls’s hormones. Stress to the pituitary – whether or not because of the 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 new study. 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 relating to ladies’s vulnerability to concussions.
“Girls normally 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 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 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 could be “referred” ache from the neck.
Different theories embody that ladies additionally might have totally different ranges of irritation, in comparison with males, Wang says. And concussions usually goal an space of the mind known as the corpus callosum, which connects the appropriate 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 consultants agree that there are widespread myths in regards to the larger frequency of concussions in ladies and their extra extreme signs.
“Some individuals suppose ladies have extra concussions as a result of they complain extra about signs, in order that they’re extra more likely to be identified,” Wang says. “I don’t like to listen to that, as a result of it suggests that ladies 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 seemingly as males to cover signs in order to not be taken out of the sport. “In truth, a number of the most pushed individuals I’ve ever met are feminine athletes,” he says.
Snedaker recommends that ladies take their signs critically. “I’ve spoken to numerous ladies who stated their concussion signs had been dismissed by docs or had been advised that they’re merely anxious.” she says.
So when 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.
Completely different Signs, Completely different Remedies?
Many of the signs of concussion – apart from menstrual dysfunction – don’t differ between the sexes, in accordance with Wang. “It’s not like a coronary heart assault, the place usually, ladies even have totally different signs than males – like nausea moderately 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, 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 ladies who’ve had a concussion about their durations. “If there’s a difficulty, comply with up with endocrine testing,” she recommends. And when you’ve had a concussion and spot adjustments in your durations, remember to deliver this as much as your supplier.
Women and men have comparable “landmarks” and “guidelines” for returning to play or to some 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 inclined to last more than these of males, “ladies must be supported all through that point,” Snedaker emphasizes. All too usually “ladies are known as ‘malingering’ or ‘mentally unwell’ after they don’t get well as quick as males.”
