Differences in Symptom Reporting Between Males and Females at Baseline and After a Sports-Related Concussion

Concussion literature and treatment guidelines are not conclusive with regards to the role of sex in symptom reporting at baseline and post-concussion. While empirical evidence is lacking, it is generally regards that females have a more severe symptomatic presentation than males at all time-points on the concussion spectrum. The aim of this study was to determine whether differences exist between males and females at baseline (pre-season/before concussion) or post-concussion for self-reported prevalence of individual symptoms as well as total symptom scores in high school and college athletes. Twenty-one studies met the criteria for inclusion: seventeen had good quality and four, acceptable quality. At baseline, females had significantly higher odds than males of reporting the individual symptoms of vision/hearing problems, headache/migraine, problems with concentration, energy/sleep disturbances, and emotional disturbances. Post-concussion, only one symptom exhibited significant differences between males and females, with females demonstrating lower odds of reporting confusion than males. Statistically, at baseline and post-concussion, females had significantly higher total symptom scores on the Post-Concussion Scale (PCS) and the Sport Concussion Assessment Tool 2 (SCAT2), but when the standard mean difference was interpreted after back-transformation, these results weren’t clinically significant.

The symptomatic presentation of males and females, most notably the prevalence of specific symptoms, is very divergent. Females had higher total symptom scores at baseline and post-concussion, however, clinically this cannot be interpreted as a meaningful difference. It is possible that these differences can be accounted for by normal hormonal changes associated with the menstrual cycle. The implications of these findings are that symptomatic presentation during an individual female’s menstrual cycle needs to be taken into consideration when making return-to-play decisions following a concussion, as returning to a completely asymptomatic level may not be a reasonable expectation.