Guest Blog: Concussions: The Gender Differences

Arleigha Cook By Arleigha Cook as a Guest Blogger

“You just have to get back out there.”

“That’s not a concussion headache.  That’s just a hunger headache.”

“Just start exercising.  That helped me.”

These quotes are all from conversations I had regarding concussions.  At a glance, I’m sure you sense a pattern.  Each of the above is a well-intentioned piece of advice, but, characterized by the notorious word “just,” each of these replies is incurably dismissive. In fact, they all tore at something inside me, as if the speaker took a look at me, saw my hope for validation of my concussion symptoms, and then pulled out the carpet from underneath me with an overtly simplistic suggestion of a quick recovery method that I should have seen before.

Interestingly, these people were brain injury survivors themselves.  And they were all male.

Hearing from another concussed individual that I should have been doing something different from the get-go – especially something as simple as beginning to exercise or just “getting back out there” was devastating.  To this day, each time I hear a suggestion of that nature, I sigh and push away an emotional reaction.  It was especially invalidating to hear from one of my friends (a skier and rugby player who had previously sustained three concussions) who said, “That’s not a concussion headache.  That’s just a hunger headache.”  To me, the pain of a “hunger headache” is the same as that of a “concussion headache.”  A hunger headache is a concussion headache.  Likewise, I have not been able to exercise without almost immediately experiencing concussion symptoms for over a year and seven months – I’m sure you can imagine how quickly I dismissed his “advice.”

These interactions got me thinking: men seem to recover from concussions more quickly than women do.  And even when they don’t, they seem to have a dismissive or nonchalant attitude about their recovery. So I started researching that idea, but only came across studies suggesting the contrary.  For example, a recent study published in the journal Radiology suggests that men actually take longer to recover from a concussion than women (see a Huffington Post article about the study here).While I have always thought I sounded like a hypochondriac, my tendency to air on the safe side may actually prove more beneficial than the laissez faire attitudes of concussed males. More than a few times I’ve come across men with concussion experience who think I’m exaggerating my symptoms (hence, “That’s not a concussion headache.  That’s a hunger headache.”).  The study featured in the Huffington Post article above even found, through diffusion tensor imaging (DTI – a form of MRI), that men seem to sustain significantly more abnormalities in a particular area in the white matter of their brains, otherwise known to scientists as the Uncinate Fasciculus.

Is this related to a basic genetic difference between men and women?  Is it the significant change to the Uncinate Fasciculus that causes male concussion patients to underestimate the time, importance, and attention their brains need in order to recover more quickly and effectively?  Presently, it’s hard to say.

My observations – which largely consist of college-age male athletes who receive concussions from football, lacrosse, and soccer – indicate that most men may have an oversimplified idea of the effort and duration involved in a timely and effective recovery.  While many women who have sustained one or moreconcussions seem to doubt their recovery or want to protect themselves through limiting exercise or other potentially dangerous activities, men seem to bear few reservations about returning to physical activity post-injury.  And, research has shown that maintaining a lower level of physical activity – if possible – can aid in the recovery process (see University of Buffalo’s 2013 study “Exercise treatment for postconcussion syndrome: a pilot study of changes in functional magnetic resonance imaging activation, physiology, and symptoms”).

This leads me to consider whether or not one’s cognitions can influence recovery speed.  There are biological differences thatinfluence concussion incurrence rates and recovery in men (such as neck strength, which can affect the damage done to the brain upon impact), but psychological state may be crucial in regards to recovery as well.  My questions: Is a healthy mental state essential for faster recovery?  Do males with concussions tend to have healthier mental states than do females with concussions?  If so, how and to what degree does this impact recovery?  My personal observation dictates that many athletes who have ended their careers as a result of concussion buildup have experienced long-term depression and anxiety because of the sudden life change due to the incurrence of brain injury.  I have especially noticed this in females.  This is not to say that males do not experience these manifestations of psychological distress; rather, it is to insinuate that psychological elements of recovery seem to affect women to a more severe degree and for a longer duration.

For now, we can only hypothesize.  The question of gender influences on concussion recovery is one that is currently being studied, and with the accelerating growth of the concussion field, there is much more to learn about gender, psychology, and outside factors that impact the recovery process.  And of course, with the more that we learn, the more we discover there is to learn.  There may be a large psychological component in recovery, and males may be predisposed to more easilyreframing cognitions surrounding this invisible injury.  Certainly there should be research done on this in the future.


Arleigha Cook is a brain injury survivor and a former soccer player and sprinter for Trinity’s Womens’ soccer and track and field teams.  After surviving her fourth concussion and receiving a diagnosis of Post-Concussion Syndrome, she has turned her focus to educating others about the effects of concussions.  An English major with a concentration in creative writing, Arleigha started a blog,, on which she posts her thoughts about her own personal experiences with brain injury.  She has also been a guest blogger for B Stigma-Free and has spoken with Elite Sports Medicine at the Connecticut Children’s Medical Center about concussions, using her personal story as an example.  Currently, she is over 1.5 years into her recovery.