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Are Women at an Increased Risk for Concussions?

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Concussions have been playing a big role in the cultural conversation this year, not least of all because of the new movie Concussion. But despite the heavy coverage of high school football helmets and pro-athlete brain damage, there's one group of heads not getting any attention: women's.

According to Jamshid Ghajar, M.D., neurosurgeon and director of the Stanford Concussion and Brain Performance Center, the scientific community has been slacking on studying C in women, despite the fact that more women than men are taking serious hits to the head. "All the studies are in helmeted males," he says. "We're not studying women playing lacrosse or soccer."

What the studies do show, is that not only do more women tend to suffer from C, they tend do fare worse when it comes to long-term effects. In fact, girls playing high school sports experience concussions at twice the rate of their male counterparts, according to a study published in the American Journal of Sports Medicine.

And it only gets worse for women from there, according to a study published in Radiology earlier this year. Concussions cause decreased activation in working memory circuits, so to take a look at long-term effects, researchers analyzed post-concussion MRI scans of men and women immediately after the injury as well as scans taken six weeks after. Six weeks after the injury, scans showed that brain activation patterns returned to normal in most men, while women continued to show decreased activity and memory impairment.

Adding to the concussion confusion is the fact that there actually isn't a widely agreed upon criterion for what constitutes a concussion. "We all know what a concussion is but there's no actual accepted diagnosis for it," says Ghajar. (High-tech healthcare could help change how doctor's diagnose concussions, though.)

According to Ghajar, a concussion involves a balance and attention impairment that follows a force to the head. "Attention is the main problem. If you can't focus or you can't do your work, you shouldn't participate in contact sports. It affects your life," he says.

So what is it about the nature of C that leaves the ladies more vulnerable? According to Ghajar, we can thank our big lady brains. Seriously.

"Women are more prone to having attention issues after a force to the head because they have big brains and small necks, as I like to put it," says Ghajar. "What happens is the force of the hit causes the head to move above the neck, which produces a whiplash effect. That's what does the damage."

We tend to think of concussions occurring when an area of our skulls get hit so hard it damages the brain underneath. But that's not what's actually going on. It's actually a product of our brain getting tossed against the front of our skull. The more flexible the neck, the greater the whiplash effect—perhaps the only bad thing about all those Bikram classes you've been taking. Typically when this whiplash happens, your brain hits the front of your skull, causing damage to the frontal lobe, which controls memory and decision-making. Hence the fogginess associated with the injury.

There's also evidence that our brain biology plays into the increased risk. Estrogen can cause hyperexcitability in your head—a fancy way of saying greater neural sensitivity. So when that whiplash does happen, the female brain may be more sensitive to damage.

But biological differences aren't the only factors at play, according to Sheena Aurora, M.D., Clinical Associate Professor, Neurology & Neurological Sciences at Stanford. "The whole aspect of gender biases plays into this," she says. "Women might not play [contact sports] as much but might try to play harder or play through it to compensate. We often don't prioritize our own health."

And when it comes to C, prioritizing your health is essential. "Most physicians will say if you have a brain injury you should rest your brain and rest your body," says Ghajar. "Essentially go into a dark room and wait for all of your symptoms to go away before you can do anything."

That sounds depressing. And it is, which is why Ghajar, who often sees prolonged symptoms of depression and anxiety in patients following concussions, doesn't recommend it. (Find out more about Your Brain On: Depression.)

Instead, activity—albeit the right kind—is the path to recovery. "Even if they have a concussion, we encourage people to do cardio exercise as part of the recovery," says Ghajar. "The first thing to do is get active." He recommends 20 minutes of cardio every other day to get blood flowing to the brain.

Secondly, it's important to make sure you pay extra attention to your sleep pattern, since problems with chronic fatigue and inability to get a full night of zzz's is often a sign of long-term symptoms.

"If you haven't recovered in a week, you should go see your doctor," says Ghajar, who says the main things docs should be looking for are issues with attention and balance.

The bottom line? Whether you're an athlete or simply fitness-focused, it's important to know your risks and use your big lady brain to take care of your head health.

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