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Understanding Women in Traumatic Brain Injury

A Workshop that Focuses on TBI in Women

"We are making advances in understanding the effects of head injury on the brain, but many of these studies have been done in males," said Patrick Bellgowan, Ph.D., program director at NINDS. "There is evidence that traumatic brain injury affects women differently, but we need focused research efforts to get a full understanding of those differences to help improve prevention and treatment strategies."


In 2017, the National Institutes of Health, in partnership with the Center for Neuroscience and Regenerative Medicine and the Defense and Veterans Brain Injury Center, hosted a workshop that focused on the unique challenges facing researchers, clinicians, patients, and other stakeholders regarding traumatic brain injury (TBI) in women in the hope of highlighting knowledge gaps, best practices, and target populations in research on females and/or sex differences within the field of TBI.


Understanding TBI in Women

Now, a new paper published in the Journal of Head Trauma Rehabilitation summarizes the issues and updates from the workshop and provides future directions.


Sex-based differences in TBI

There are sex-based differences in TBI across all ages. In children of 0-4 years old, boys are two times more likely to have a TBI than girls, but during the adolescent years, female athletes are more likely to experience concussions than male athletes. Among older populations, women who are 65 and older are most likely to experience mild TBI--concussion, and the majority of those result from falls.


Menstrual Cycle-related TBI

Depending on when during women's menstrual cycle they were injured, they may have different outcomes following TBI. Head injuries occurring during the luteal phase of the menstrual cycle, when levels of progesterone are high, may be associated with worse outcomes and decreased quality of life. The test of this theory is performed based on the observation that worse outcomes for women were most pronounced during childbearing years, which suggested a role for sex hormones such as estrogen or progesterone. The results are shown to prove the theory. Therefore, women may experience worse outcomes than men because men have consistently low concentrations of progesterone.


Military-related TBI

Not much is known about military-related TBI in female servicemembers. Studies have reported sex-based differences in symptoms as well as the activity between brain regions, but there are also studies that have shown similar phenotypes of men and women. Therefore, the evidence available to examine the issue of sex differences in military-related TBI is weak. Increasing the number of female veterans in longitudinal research studies would increase knowledge about acute and long-term recovery of TBI in women.


"Current studies are underway to addressing the impact of implementing sex- and gender-informed knowledge transfer materials as this is currently a gap in the literature."



Valera, Eve M., et al. “Understanding Traumatic Brain Injury in Females: A State-of-the-Art Summary and Future Directions.” Journal of Head Trauma Rehabilitation, vol. 36, no. 1, 2021, pp. E1–17. Crossref, doi:10.1097/htr.0000000000000652.


“Identifying Strategies to Advance Research on Traumatic Brain Injury’s Effect on Women.” ScienceDaily, 6 Jan. 2021,


Image: Sebastian Kaulitzki/Getty Images

Resources by Judy Zhu

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