Concussions may look different in male and female brains

In 5 seconds Biological sex may be an important factor to consider in managing concussions in athletes – and deciding when they can return to play.
One of the study’s key findings relates to the differences observed between the sexes even before a concussion occurs.

Concussions are among the most difficult injuries to assess in sports. The symptoms—fatigue, trouble concentrating, headaches, anxiety—vary widely from one athlete to the next, which can make a safe return to play hard to navigate.

A research team based at Université de Montréal worked with Cégep Montmorency to better understand what happens inside an athlete’s brain before and after a concussion, and to determine whether these changes differ between young women and men.

Led by Mariane Doucet, then a doctoral student supervised by Michelle McKerral, a professor in UdeM’s Department of Psychology, examined the resting electroencephalograms (EEGs) of 115 student-athletes between the ages of 16 and 22,.

Of those, 31 were women. Thirty of the athletes, eight of whom were women, later suffered a concussion during training or competition and were re-evaluated using the same measures.

One of the most striking findings of the study was the pre-concussion differences between the sexes. At baseline, the young women had higher beta wave power—rapid waves between 12 and 30 hertz (Hz)—than the young men.

High levels of low-beta power (between 12 and 20 Hz) are generally associated with heightened alertness and vigilance, though in certain contexts they can also signal stress or anxiety. 

An increase in high-beta power (between 20 and 30 Hz) is more specifically associated with stress or anxiety.

A different approach

This finding is significant because EEG analyses have often lumped men and women together to calculate average baselines, an approach that may obscure significant biological differences.

“The brains of female and male athletes do not necessarily have the same ‘electrical profile’ at the outset,” Doucet said. “This distinction is important when we are trying to detect the effects of a concussion.”

The observed post-concussion changes must be interpreted with greater caution, Doucet said. As the number of concussed athletes in the sample was smaller, the conclusions remain exploratory.

While no statistically significant differences can be confirmed with certainty, a trend did emerge: there was a decrease in theta waves following injury, in both males and females.

Theta waves are often linked to attention, working memory and decision-making—functions that are frequently disrupted after a concussion. 

“A decrease in theta waves could reflect disturbances in certain cognitive functions, such as the ability to concentrate, retain information in the short term, or make quick decisions,” Doucet said.

In a sports context, these functions are crucial, she added. Players who comes back too soon may have more trouble following the action, anticipating movements or reacting effectively, even if their subjective symptoms appear to have faded.

No single profile

Doucet believes there is probably no single brain signature indicative of concussion. There may be multiple profiles, depending on the individual, the type of impact and the person’s history.

Scientists are therefore looking for tools that are more objective than the tests currently in use, which are often based on cognitive or physical performance. The results of these tests can vary depending on the athlete’s motivation, level of fatigue and performance on the baseline test taken before the season began.

EEGs could potentially offer a more objective physiological measure of recovery that could be used to track the brain’s progress after an injury. However, Doucet remains cautious: a clinical tool ready for use in the field is still a distant prospect.

“The next step could involve combining several types of physiological measurements,” she said. “We’re particularly interested in heart-rate variability, which is an indicator of autonomic nervous system function.”

This approach could eventually improve athlete monitoring and provide more reliable criteria for deciding when it is safe to start playing again, she added.

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