When Karen Murray’s 9-year-old daughter called for her in the middle of the night, she jumped out of bed to check on things. She remembers then that her legs gave way and she fell, landing with her head on the nightstand as she fell. The Philadelphia native, who is 44 years old, claims, “I blacked out.” I stood up after a few seconds, but I was shaky and nauseated. Murray felt like she was going to vomit for the next 20 minutes while her husband went to check on their daughter. Murray fell back asleep after the nausea subsided.
However, the mother of two experienced a pounding headache the following morning. She had bouts of nausea and dizziness the rest of the day. Murray called her mother, a nurse, to tell her what had happened the night before and how she still felt “off,” while she was waiting for her son’s soccer practice to end. Concerned that her daughter had suffered a concussion, her mother advised her to visit the emergency room.
Murray asserts, “I wasn’t thinking I had a concussion.” I’d always assumed that only football players or people in serious accidents like car crashes experienced that. However, when Murray went to the hospital, the ER doctor ordered a CT scan, and Murray was confirmed to have suffered a mild concussion.
Postdoctoral researcher Abigail Bretzin, Ph.D., who works at the Penn Injury Science Center at the University of Pennsylvania, doesn’t find it surprising that Murray didn’t initially recognize that her head injury might be as severe as it was. According to Bretzin, who studies sex differences in concussion outcomes, “it really hasn’t been recognized that concussion and traumatic brain injuries occur as frequently in women.” Men have generally been the focus. Additionally, we are aware that women’s brains may be more vulnerable, despite the fact that men have a higher overall rate of concussion. You can protect your brain for many years to come by knowing why a brain injury occurs and the signs and symptoms of one.
What happens to your brain after a concussion
The good news is that most people who get a concussion recover completely; Dr. Smith says that about 80% of them are fine. Additionally, researchers are attempting to ascertain precisely why the remaining 20% perform poorly. Even if you are beginning to feel a little better, Dr. Smith warns that getting medical attention is essential even if the odds are in your favor of a full recovery from a head injury. We take head injuries very seriously and almost always order a CT scan to check for bleeding in the brain, which can cause those axons to grow and kill them—and you—if they get too big.
Bretzin asserts that earlier treatment also assists in identifying treatment strategies that may result in improved outcomes. It can be challenging to diagnose and treat a concussion because not everyone with one presents with the same symptoms, she states. However, if we are able to keep an eye on your symptoms, we will be able to better direct you to treatments that might help prevent long-term effects. For instance, if you have a head injury and your balance is off, you may need to see a physical therapist; A visit to a neuropsychologist may be necessary for cognitive impairments like brain fog or a shorter attention span.
The XX factor: Why women’s brains are more vulnerable
Fortunately, a CT examination of Murray’s brain the next day revealed no internal bleeding. Her symptoms, however, persisted for nearly three months. She suffered from regular headaches and discovered that staring at her computer screen or watching TV for more than an hour at a time caused severe headaches.
Smaller bodies, larger issues
According to Angela Colantonio, Ph.D., a professor at the Rehabilitation Sciences Institute at the University of Toronto who conducts research on traumatic brain injuries, “these continued concussion symptoms may have something to do with anatomical differences between males and females.” These differences cause women to experience more severe symptoms than men do and to take a longer period of time to recover from a concussion.” First of all, women’s necks are typically shorter and thinner than men’s, making them more susceptible to rotational forces that can damage the brain, according to Colantonio. Women’s head and neck “angular acceleration,” a measure of head impact thought to be a cause of brain injury, was found to be significantly higher in a study of female soccer players, who are more than twice as likely to sustain concussions as their male counterparts. According to Bretzin, these biomechanical differences make men’s stronger necks better able to withstand head impacts that result in concussions.
Dr. Smith adds that there are also anatomical differences in the brain that may make the female brain more vulnerable to a head injury. The axons of women tend to be smaller when compared to those of men. Dr. Smith explains, “We find that there is far less swelling and sodium influx in male axons compared to females when we do in vitro models, where we take human neurons and micropattern them into a human brain and induce the same kind of rapid stretching of those axons that happens in concussion.” Male axons appear to rebound, whereas female axons are pushed toward bad pathways by the same force, leading to more axon disconnection and persistent sodium issues in the brain. According to researchers, the male brain is better able to withstand impact due to its larger axon size.
The role of estrogen
Colantonio adds that hormones may also influence how women recover from head injuries. In point of fact, research demonstrates a clear link between a woman’s menstrual cycle and her likelihood of recovering from a brain injury. According to a 2014 study, women who sustain a concussion during the luteal phase of their menstrual cycle—the two weeks immediately following ovulation, when estrogen and progesterone levels are at their highest—have worse outcomes a month later than women who sustain head injuries during the follicular stage—the two weeks immediately following menstruation, when estrogen and progesterone levels are at their lowest levels. It’s interesting to note that women who used oral contraceptives and women who had reached menopause also fared better after a concussion. According to the researchers, a blow to the head can cause the pituitary gland, or the center that controls hormones in the brain. If the pituitary slows down when hormone levels are high, the symptoms get worse and last longer if hormone levels drop quickly; That drop-off has less of an effect if hormone levels are already low.
Other risks of being a woman
Then there are gender connections, says Colantonio, “which aren’t about the biological characteristics of males vs women but rather our socially created roles.” Consider the prevalence of gender-based violence throughout the world, with one in every three women experiencing intimate partner abuse at some time in their life. “Common regions of damage include the head, face, and neck,” adds Colantonio, “and those injuries tend to be repeated.”
How to Keep Your Brain Safe From Concussions
While you can’t avoid everything that might cause a brain injury, doctors say there are a few precautions you should take.
Step 1: Consider how you may reduce your chance of falling.
The current focus of Bretzin’s research is on how to avoid concussions in the first place. She says that the answer could be as simple as avoiding certain risky behaviors or wearing protective gear, such as a bike helmet that fits properly.
Colantonio says it’s also important to know that older people are one of the most likely to get concussions, so it’s especially important to look at your risk of falling as you get older. She says, “It’s easy to think of falls as accidents, but you can do a lot to prevent them.” Even wearing well-fitting shoes, getting enough sleep, not getting up too quickly, and exercising to build strength and balance can help you stay safe. Colantonio even suggests consulting an occupational therapist for a home safety assessment that will look for potential trip hazards and offer design suggestions to keep you safe.
Step 2: See a doctor immediately after a bump to the head.
One of the most crucial things you can do is detect and treat a brain injury as quickly as possible, according to Bretzin. “Seeking treatment quickly after being harmed can greatly assist prevent or lessen long-term repercussions,” she explains. Dr. Smith concurs, noting that consulting a specialist is especially vital if you have a concussion. “If you get a concussion and go to your primary care doctor, he or she might not know who to recommend you to,” he explains. “Ask for a concussion expert, who will have greater experience with head injuries and can direct you to particular rehabilitation methods and, maybe, scientific trials.”
Step 3: Recognize that there are things you can take to mitigate the long-term effects of a concussion.
Many persons who have suffered a brain injury have their symptoms subside. However, some people, particularly women, may suffer long-term consequences. Bretzin advises everyone who falls into this category to speak out about their suffering. “Talk to your doctor or other healthcare professionals about your awareness that women are more likely than males to experience chronic symptoms following a concussion,” she advises. “Inquire about rehabilitation programs and support groups for other concussion survivors. It’s critical to know that your problems may necessitate ongoing treatment and control, and there are professionals who can assist you along the way.”