High-impact sports like basketball, cheerleading, hockey, lacrosse and soccer come with an increased risk of head injury for any athlete. But growing research suggests that female athletes can be more vulnerable to concussions than their male counterparts in sports with similar rules. They may also experience more symptoms and longer recovery times.
That shift in understanding marks a change from earlier assumptions, when experts believed men had higher concussion rates simply because they participated more often in contact-heavy sports like football and hockey. As more women compete at higher levels, researchers are taking a closer look at how concussion risk -- and recovery -- may differ.
Why concussions may be more common in women
While no single factor fully explains the difference, experts point to several possible reasons female athletes might face higher concussion rates in comparable sports.
- Neck strength may play a role
One key factor is neck strength. Athletes with less neck stability may have a harder time controlling head movement during impact, increasing the likelihood of injury.
“It’s more than an age or gender difference. It’s the muscle bulk involved in the task or activity,” said Dr. Baibing Chen, neurologist at Henry Ford Health.
On average, female athletes tend to have smaller and less muscular necks than males. But researchers report strength matters more than size alone. Studies have shown that for every 10% increase in neck extension strength, concussion risk may drop by about 13%.
- Hormones could influence response to injury
Hormonal differences may also play a role, though research is still evolving. Scientists are continuing to study how hormones like estrogen and progesterone affect the brain’s response to injury.
Emerging evidence suggests that factors like menstrual cycle phase and progesterone levels could influence both symptom severity and recovery time, though findings are not yet consistent.
Based on current knowledge, hormone fluctuations throughout the menstrual cycle likely impact how concussions present and progress, according to Dr. Chen.
- Symptom patterns and reporting differences
Concussion symptoms aren’t the same for everyone -- and preexisting conditions can influence how they appear.
“If someone has a propensity for migraine headaches, they’re more likely to have a concussion with migraine-like symptoms, including headache and light and movement sensitivity,” Dr. Chen said.
Because women are more likely to experience migraines after puberty, they may also be more prone to these types of concussion symptoms. Research also shows that female athletes tend to report more symptoms both before and after a concussion -- and may be more likely to communicate those symptoms to coaches or medical staff.
That raises an ongoing question for researchers: Are concussions actually more common in female athletes, or are they simply identified more often because symptoms are reported more consistently?
Recognizing concussion
Awareness around head injuries has improved in recent years, but not every hit to the head results in a concussion -- and not every symptom should be assumed to be one.
“When an athlete reports symptoms after a hit, it’s important for trainers and medical professionals to consider all possible reasons for the symptoms,” Dr. Chen said. “You want to make sure you’re not assuming the athlete has a concussion, for example, when she’s suffering from a migraine or neck injury. Of course, you also want to make sure you’re not diagnosing only a concussion when an athlete has something much more serious like a brain bleed.”
That’s why proper evaluation is critical. Experts recommend athletes undergo a baseline assessment with a sports neurologist before the season begins -- and repeat it annually.
These evaluations give medical teams a clearer point of comparison if an injury occurs, which helps them determine whether changes in brain function are temporary or more serious.
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