Understanding Traumatic Brain Injury in Females: A State-of-the-Art Summary and Future Directions

Abstract

In this report, we identify existing issues and challenges related to research on traumatic brain injury (TBI) in females and provide future directions for research. 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 TBI in women. The goal of this “Understanding TBI in Women” workshop was to bring together researchers and clinicians to identify knowledge gaps, best practices, and target populations in research on females and/or sex differences within the field of TBI. The workshop, and the current literature, clearly highlighted that females have been underrepresented in TBI studies and clinical trials and have often been excluded (or ovariectomized) in preclinical studies. Such an absence in research on females has led to an incomplete, and perhaps inaccurate, understanding of TBI in females. The presentations and discussions centered on the existing knowledge regarding sex differences in TBI research and how these differences could be incorporated in preclinical and clinical efforts going forward. Now, a little over 2 years later, we summarize the issues and state of the science that emerged from the “Understanding TBI in Women” workshop while incorporating updates where they exist. Overall, despite some progress, there remains an abundance of research focused on males and relatively little explicitly on females.

Mild traumatic brain injury affects the features of migraine

“…While the nature of the reported physical abuse was not investigated in this study, it is notable that our sample was predominately female. Domestic violence occurs in approximately 1 in every 4 women in the United States, and up to 94% of injuries women sustain from abuse are to the neck and head [67][68][69]. Thus, given the prevalence of migraine in women, and the high rate of domestic violence and repetitive head injuries these women sustain, a history of domestic violence and physical abuse should be a part of the clinical evaluation of women with migraine.…”

Exploring Age and Sex Patterns for Rehabilitation Referrals After a Concussion: A Retrospective Analysis

“… 30 , 31 There are no established reasons why women have more concussions or more severe concussions than men, although factors including hormones and musculature have been discussed as possibilities. 32 , 33 Perceived severity of concussion and prolonged symptoms are established factors in seeking care, 24 which may provide some explanation for the sex discrepancies reported herein. In this study, sex had a significant association with preexisting comorbidity diagnosis, which aligns with the literature regarding comorbidity diagnoses patterns.…”

“…Increased likelihood of these comorbidities in women aligns with previous literature, highlighting the need to factor the presence of comorbidities into postconcussion care. 32 , 33 …”

Systematic Review of Sex and Gender Effects in Traumatic Brain Injury: Equity in Clinical and Functional Outcomes

“…The growing evidence showing that men and women experience TBI differently and may thus necessitate different approaches in preventive efforts and response post-injury has compelled funding agencies, the federal government, and researchers to implement requirements for the explicit consideration of sex/gender in research and clinical contexts (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21).…”