Concussions are worse for women—but the research lags behind
Industry Buzz
Some studies suggest that female athletes may experience delays in evaluation or referral to specialty care, and those delays may contribute to higher rates of prolonged symptoms.
—Caitlyn Mooney, MD
Female athletes sustain fewer and lower-magnitude head impacts than their male counterparts—yet they are more likely to develop concussions and experience more severe, prolonged symptoms.
A major 2024 review highlights this paradox, showing higher concussion incidence and greater neuropsychological burden in female athletes despite reduced exposure.[] The reasons remain incompletely understood, but proposed contributors include biomechanical differences such as lower neck strength, as well as differences in symptom reporting and recognition.
For clinicians, these differences carry practical implications: from risk counseling and prevention strategies to recognition and referral patterns.
Here’s a refresher on what you need to know about counseling female patients—whether they play contact sports professionally or are about to pick up a hockey stick for the first time.
Can strength training help?
“Decreased neck strength may explain why women are more likely than men to receive a concussion in contact sports. Women are more likely to report symptoms of concussion than men,” Steven Erickson, MD, Chief of Primary Care Sports Medicine at Banner Health, tells MDLinx.
The 2024 review found that despite receiving fewer impacts and impacts of lower magnitude than their male counterparts, female athletes have a higher risk of receiving a concussion.[]
Researchers also found that female athletes had worse symptoms following a concussion, along with higher levels of neuropsychological deficits.
Dr. Erickson says physicians can help their female patients by encouraging them to do appropriate strengthening exercises to reduce risk of concussion: “Neck strengthening exercises would be helpful in decreasing concussion risk in females. All athletes should report symptoms following head trauma and have an evaluation by a provider with experience in sports-related concussion,” he tells MDLinx.
What matters most in the clinic
Caitlyn Mooney, MD, is a sports medicine physician at Vanderbilt University. She says that timely evaluation of concussions is crucial, but notes that females are more likely to experience delays in evaluation or referral to specialty care compared with males.
"Those delays may contribute to higher rates of prolonged symptoms," Dr. Mooney says. "This can reflect differences in recognition, as well as differences in access, particularly in settings where girls’ sports may have less consistent medical coverage. Because of that, one of the most impactful steps we can take is ensuring timely evaluation. Early recognition and referral to appropriate care can reduce the risk of prolonged symptoms.”
She argues that timely evaluation could also be improved by providing proper education to families regarding concussion risk.
“It’s also important to educate families—not just athletes in organized sports—so that symptoms are recognized and evaluated promptly, even outside of school-based programs. Improving access and reducing delays in care is likely one of the most meaningful interventions we can make today,” Dr. Mooney explains.
What next?
Dr. Erickson notes that there are still many unknowns in the differences in experiences between male and female athletes and concussion. He emphasizes that physicians have an important role to play in properly evaluating and treating those symptoms when they are reported.
“We do not fully understand the differences between male and female concussion recovery. Providers should be aware that females may report more symptoms of sports-related concussion, and [they should] evaluate each symptom and treat appropriately. All patients should be evaluated for vestibular (balance), visual, and cognitive dysfunction and should not be cleared to return to play until all symptoms and temporary neurologic dysfunction have resolved,” he tells MDLinx.
Expert counseling tips from Steven Erickson, MD
Patients with dizziness or balance issues may benefit from referral to a vestibular therapist
Patients with visual dysfunction should be evaluated by a neuro-optometrist and considered for vision therapy
Patients with cognitive symptoms should undergo computerized neurocognitive testing or formal neuropsychological evaluation