Concussions affect women differently, but medicine still treats them the same (2/6/25 Newsletter)
This week, our lead article, Concussions affect women differently, but medicine still treats them the same, is in the Women’s Health category.
In this newsletter: Opportunities, Sports, Concussion Alliance Webinar Announcement, Self-Care, Therapies Currently Available, Tell Us Your Story, and Women’s Health.
We appreciate the Concussion Alliance volunteers and staff who created this edition:
Writers: Josh Wu, Savannah Hunt, Fadhil Hussain, and Myla Hightower
Editors: Malayka Gormally and Conor Gormally
Do you find the Concussion Update helpful? If so, forward this to a friend and suggest they subscribe.
Opportunities
Tuesday, February 25, 6 pm EST: A free webinar, Return to Athletics, Principles and Who to See, presented by Dr. Michael Hutchison, hosted by the Canadian Concussion Centre. Register in advance.
Thursday, February 27, 11 am PST: A free online class, Sleep Hygiene with Regee, presented by Regee Costanzo, Survivor Engagement Coordinator, and hosted by Brain Northwest. Register in advance.
Wednesday, March 5, 9:30 - 11:30 am EST: A low-fee workshop, Minds Matter Concussion Model: Acute Clinical Concussion Management, is a “professional education event to discuss implementing an acute concussion management plan for youth.” Presenters are some of the top professionals in the field, including Christina L. Master, MD. Fee: Student $25, and General Admission, $30. CE credit is available for Athletic Trainers ($45), Nurses ($55), and Physicians ($75).
Call for study participants: military veterans who have had exposure to blasts, concussions, and/or a traumatic brain injury, including any injury to your head or neck that caused you to lose consciousness or feel dazed/confused/experience a gap in memory. Read our blog post for more information on the Late Effects of TBI (LETBI) study. If you are interested, please contact Julia Kirschenbaum at julia.kirschenbaum@mountsinai.org, call us at 212-241-5152, or sign up online.
Sports
Guardian Caps and concussion prevention
A CNN article explores the nuance of the NFL's use of Guardian Caps—padded, soft-shell covers placed over standard helmets—to reduce the intensity of head impacts among players. The NFL claims these helmets have reduced concussions, but research suggests Guardian Caps have no effect. The article offers a detailed understanding of these caps, which have emerged as a key issue for player safety in football.
In 2024, the NFL required Guardian Caps during training camp practices for positions that experienced head impacts frequently. According to Jeff Miller, the NFL's executive vice president in charge of player health and safety, league data showed that players who wore these caps during the 2024 preseason experienced a 52% decrease in concussions compared to the past two seasons. This statistic indicates a considerable beneficial effect on player safety. However, there is no published data to back up the NFL's claim of concussion reduction.
Independent studies provide a more nuanced perspective. According to a study published in the Journal of Athletic Training, Guardian Caps were assessed for their ability to reduce impact effects in D1 college football players. The study concluded that these caps did not offer measurable protection from head impacts. Likewise, a study published in 2023 investigated head impact kinematics with instrumented mouthguards and discovered no significant differences in head impact metrics when players wore Guardian Caps. These results call into question how effective the caps are in reducing concussions in real-world scenarios.
The reception of Guardian Caps among players has been varied. Although certain athletes value the added protection, others raise issues about comfort, appearance, and possible changes to the game's dynamics. The caps' hefty look has caused hesitation among players to wear them in games. This uncertainty underscores the balance athletes aim for between security and efficiency, along with the visual elements affecting gear approval in competitive sports.
Guardian Caps signify a proactive measure taken by the NFL to improve player safety by potentially lessening the intensity of head impacts. Grasping the effect of caps on long-term brain health is essential, particularly in light of increasing worries about chronic traumatic encephalopathy (CTE) and other neurodegenerative disorders linked to repetitive head impacts. Nevertheless, the existing research shows differing outcomes regarding their effectiveness compared to what the NFL is saying. The contrast between the NFL's claimed decline in concussions and outside research challenging the helmets' protective effectiveness highlights the difficulty of tackling head injuries in contact sports. As the league persists in enforcing and evaluating safety protocols, the significance of independent, peer-reviewed studies cannot be emphasized enough in steering evidence-based choices to safeguard athletes' well-being.
March is Brain Injury Awareness Month, and we're hosting a webinar for our community!
Join us on Wednesday, March 13th at 4 pm EST | 3 CST | 1 PST for a virtual "lunch and learn" with Concussion Alliance Co-Founders Conor Gormally and Malayka Gormally.
This webinar is free to our community and will include a crash course on the most up-to-date best practices for concussion recovery, a few of our personal highlights from recent Concussion Update Newsletters, and more about our story and journey from concussion patient and advocate to building a nonprofit.
We will also have a Q&A, so you'll have the opportunity to ask us any burning questions!
Here are the details:
March 13th at 4 pm EST | 3 CST | 1 PST
Google Calendar Link
We look forward to seeing you there!
Self-Care
Two PDFs for patients on managing mental health problems following concussions
The January 2025 Transcendent newsletter promoted helpful, informative PDFs on Concussion and Mental Health and A Guide to Mindfulness. These PDFs are a tool to help patients manage their mental health symptoms from concussions. Concussions can exacerbate any existing mental health issues, as well as cause subsequently new mental health symptoms, as explained by Dr. Roger Zemek in this excellent two-minute video. The January Transcendent newsletter focused on concussions and youth mental health; the newsletter is a joint publication of the Transcendent Concussion Research Program, Pedsconcussion, and 360 Concussion Care.
The Concussion and Mental Health PDF covers concussion-based factors contributing to mental health problems, common mental health symptoms, and different ways of managing mental health, including self-care coping strategies and seeking provider-based care for therapy or medication. A Guide to Mindfulness explains the three key components of mindfulness, provides simple instructions on how to practice this skill, and discusses the potential benefits. 360 Concussion Care published these PDFs several years ago; however, the information is still accurate and relevant for concussion recovery. Concussion Alliance also has many resources on mental health, including how an invisible injury such as a concussion can impact your mental well-being. There are also resources on different meditation practices, such as movement meditation and body-mind training, to help aid concussion recovery.
A 2022 study evaluated the risk of mental health problems in children and youths following concussion and found that youths who suffer a concussion are 40% more likely to experience a mental health issue than youths with an orthopedic injury. Some factors contributing to mental health problems following concussions include feelings of isolation from stepping back from daily activities, lack of understanding of one’s symptoms or the course of recovery, lack of support from peers (especially among children), disruptions in sleep, and stress from falling behind due to injury. Mindfulness allows the brain moments of peace that can decrease stress and anxiety by bringing attention and awareness to how the body feels. The main components of mindfulness include staying in the present moment, approaching thoughts with curiosity, and paying attention. Mindfulness also increases attention to emotion, which helps manage mental health issues. In addition, concussions often cause chronic pain in the head, neck, and shoulders. Mindfulness helps alleviate chronic pain, contributes to pain management, and improves cognition––especially in concentration, focus, and problem-solving domains. These two PDFs on Mindfulness and Mental Health offer tools for patients to help with mental health problems that might arise as they recover from a concussion.
Therapies Currently Available
After a concussion, active management is the most effective treatment
A clinical practice guideline (CPG) published in the New England Journal of Medicine recommends 24–72 hours of relative rest after a concussion, followed by a gradual return to activity and exercise. In an associated University of Buffalo press release, Dr. John J. Leddy, author of the CPG, explains that controlled reintroduction of activity helps the body adapt to post-concussion physiological changes, promoting faster recovery and reducing the likelihood of persistent symptoms.
The guideline incorporates the 6-stage return-to-sport strategy from the Sixth Consensus Statement on Concussion in Sport, beginning with symptom-limited activity and progressing through aerobic exercise, sport-specific training, and full-contact practice. Leddy extends these principles beyond athletics, recommending early return to school with accommodations such as extended assignment deadlines, rest breaks, and postponed tests. Concurrent symptoms like neck pain and oculomotor and vestibular impairments should be treated with physical therapy. Repeated NSAID use for headaches should be avoided due to the risk of medication-overuse headaches. Good sleep hygiene, symptom-limited daily activities, and weekly follow-ups are emphasized.
For exercise-based rehabilitation, Leddy suggests starting with daily walking or stationary cycling at 50% of the age-predicted maximum heart rate (220 minus age). Activity should continue unless symptoms increase significantly. [See our Guidelines for Recovery for an explanation (based on the 6th consensus) of how to judge the appropriate level of exertion based on symptom levels.] Patients aiming to return to sports can begin sport-specific training once they tolerate 20 minutes of aerobic exercise at a 70% maximum heart rate. Additionally, in the press release, Leddy recommends educating patients and families that “current evidence does not show that concussions in former amateur athletes (high school, college) is a risk for neurological disease (e.g., dementia) later in life.”
The guideline reinforces the growing evidence that early, controlled exercise aids concussion recovery. Leddy notes that exercise intolerance often stems from autonomic nervous system dysfunction post-concussion and that individualized aerobic rehabilitation, initiated within 2–10 days of injury, can significantly reduce the risk of prolonged symptoms.
We'd love to hear from you!
Are you a concussion patient or advocate? Please tell us your story and how our resources have helped.
Are you a professional? Please tell us how our resources have been helpful to you.
Women’s Health
Concussions affect women differently, but medicine still treats them the same
In an article for Women’s Health, journalist Olivia Luppino discusses “What Doctors Want You To Know” about concussions. Emerging research indicates that women may experience concussions more frequently and with more severe symptoms than men, potentially due to hormonal fluctuations and structural differences in brain anatomy. While symptoms like dizziness, memory issues, and headaches are common across sexes, women often report prolonged symptom duration compared to men. Experts point to estrogen and progesterone fluctuations as potential factors influencing symptom severity and recovery time. Some women also experience worsened symptoms during certain phases of their menstrual cycle, suggesting that hormonal changes may affect recovery.
Additionally, anatomical differences may contribute to women’s increased vulnerability to concussions. For example, compared to the male brain, the female brain has smaller axons, and the axons have fewer microtubules (which provide structure to the axons), making them more vulnerable to breakage during an impact. Luppino also mentions variations in neck strength, referencing a 2021 study that hypothesized that lower neck strength may contribute to women’s increased concussion vulnerability, and studies have found that women have weaker necks. However, Concussion Alliance covered a 2023 study that shows there is no significant relationship between greater neck strength and lower risk of sports-related concussion.
Despite findings of significant differences for women, most concussion research has historically focused on male athletes, leading to gaps in diagnosis and treatment strategies for women. As a result, many female patients face delayed diagnoses and treatment plans that don’t take into account recovery elements specific to women, further complicating their recovery. Clinicians emphasize the need for sex-specific approaches to concussion management to ensure better patient outcomes.
One claim in the article is that concussions may impact fertility, though this is based on a single individual’s experience; Concussion Alliance is not aware of any research showing that concussions affect fertility. However, some research findings suggest that concussion can disrupt the endocrine system, affecting hormone levels and the menstrual cycle. For more information, see our resource on Women and Girls, which addresses hormones and the menstrual cycle in relation to concussion.
As awareness grows about these sex-specific differences, medical professionals stress the importance of research that fully considers female physiology and hormonal cycles. By expanding concussion studies to include more women and developing targeted treatment protocols, clinicians can improve recovery outcomes and close longstanding gaps in care. Ensuring that women receive the attention and resources they deserve is a crucial step toward more equitable and effective concussion treatment.