The Concussion Gender Gap: Why Female Athletes Score Differently at Baseline and Recover Differently After

Concussion science has a gender problem. The vast majority of concussion research — and the protocols built on that research — was developed using data from male athletes in football and hockey. But female athletes get concussions too, and their experience is measurably different in ways that matter for baseline testing and management.

Different baselines

At baseline, female athletes tend to report more symptoms than males. Research published in the Journal of Athletic Training(Covassin et al., 2017) found that women score higher on verbal memory tasks but lower on visual memory and visual motor speed compared to men. They report higher rates of headache, fatigue, and difficulty concentrating as part of their normal, healthy function. These differences aren’t deficits — they’re normal sex-based variation. But if a female athlete’s post-injury scores are compared to male-dominated normative data, the comparison can produce misleading results.

Different recoveries

After concussion, the differences continue. A 2013 meta-analysis published in the American Journal of Sports Medicine (Broshek et al.) found that female athletes may take longer to recover, report more severe symptoms, and experience higher rates of specific symptoms including migraine-type headaches and vestibular dysfunction. Some researchers attribute this to hormonal influences — estrogen and progesterone levels affect brain metabolism and cerebral blood flow — while others point to greater willingness among female athletes to report symptoms accurately, as documented by research in the British Journal of Sports Medicine.

Girls’ soccer leads female high school concussions

According to the NCAA Injury Surveillance System, girls’ soccer is the number one cause of sport-related concussions among female high school students, yet the sport receives a fraction of the concussion research attention devoted to football. A study published in Head Impact Measurement Devices (PMC) noted that female athletes in some sports sustain concussions at twice the rate of their male counterparts, with researchers suggesting this may result from biomechanical factors including lower neck strength.

Why individualized baselines matter more for female athletes

Individualized baseline testing is the most effective way to account for sex-based differences. When a female athlete has her own baseline data — including her normal symptom profile, her specific cognitive scores, and her balance performance — the post-injury comparison is valid regardless of what population-level data says.

At Headquarters, we ensure baseline assessments are interpreted within the context of each athlete’s individual profile, including sex-based considerations. Because the goal of a baseline is to know what normal looks like for this person — not for the average person in a research database. For related context, see our piece on soccer’s heading controversy and what it means for baselines.

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