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Girls' concussion symptoms may differ from boys', physicians say

- By Louis Bergeron

Courtesy of the James family description of photo

Ava James suffered a head injury during soccer practice in July.

At soccer practice last July, 13-year-old Ava James bent down to retrieve a ball near a goalpost when another player's shot struck her on the side of the head. The impact propelled her head into the metal post. Dizzy and a little nauseous, Ava sat down. Fifteen minutes later, feeling better, she resumed practice.

Afterward, her head began hurting again. When the pain persisted through the next few days of school, Ava told her mother, Alexandra. Ava's pediatrician referred her to Paul Fisher, MD, at Lucile Packard Children's Hospital.

As soccer, lacrosse, basketball and other popular "incidental contact" sports have grown in popularity among girls, so has the concussion rate, rising about 21 percent for these young athletes each year over a recent 11-year stretch, according to a study in The American Journal of Sports Medicine.

With these trends in mind, writer Louis Bergeron discussed the topic with Fisher, chief of pediatric neurology at Packard Children's and professor of neurology at the School of Medicine, and pediatric neurosurgeon Gerald Grant, MD, associate professor of neurosurgery at the School of Medicine. Grant, a U.S. Air Force veteran, treated soldiers with blast concussive injuries in Iraq.


Q: What are the symptoms of a concussion?

Fisher: A concussion is a head injury that causes temporary impairment of normal brain function, such as loss of awareness or alertness. Girls and boys tend to report different symptoms of concussion and may also describe the same symptoms differently. Boys often report symptoms that are fairly severe — confusion, bad headaches, forgetting — while girls may report milder symptoms, such as drowsiness, malaise or noise sensitivity. But that doesn't mean a girl's concussion is any less severe.

A big problem here is that when a girl reports milder symptoms to a male coach — and a lot of coaches in girls' sports are male — her concussion could be missed if the coach isn't alert to the differences in how boys and girls report symptoms.

Q: Are girls more vulnerable to concussions than boys?

Grant: We don't know enough to say, but there is a lot of interest and a lot of research into whether gender plays a role in the vulnerability to head injury. The Department of Defense has become particularly interested in this issue lately because of the increasing numbers of female combat soldiers.

Q: What can be done to reduce the incidence of concussions?

Fisher: Probably the most effective way to reduce the number of sports-related concussions is to enforce the rules of whatever game is being played.

That's particularly important in girls' sports, because when the level of play and the rules are the same, girls get more concussions than boys. Why? No one knows.

Q: What can be done to reduce the effects of a concussion?

Fisher: Spot it early. Everyone should know the symptoms of concussion. Having coaches and parents keeping an eye out for symptoms isn't enough — players need to watch out for each other.

A lot of times athletes are reluctant to report concussion symptoms — theirs or another player's — because they're afraid of being thought of as wimpy, or hurting the team. But they should understand that the sooner they acknowledge a concussion, the less playing time they will lose.

A kid who gets a concussion has to sit out sports for a while. It's paramount to keep them from getting a second concussion before the first one has healed.

Q: Kids need to reduce physical activity after a concussion, but what about mental activity?

Grant: After some initial rest — which could be less than a day to a couple of weeks, in severe cases — it's okay to stimulate kids' brains. But it should be in short pulses — no more than 30 minutes of any particular activity, so their brain doesn't get fatigued. That applies to watching TV, playing video games, reading and schoolwork.

If a child has to cut back on schoolwork or attendance at first, it may be best for them to gradually work back to a full school day. The classroom can be very difficult for a boy or girl recovering from a concussion because there is so much activity going on. They may have trouble listening, their memory may not be up to par and they may not have their usual stamina.


Fisher saw Ava two weeks after her concussion. She hadn't played soccer in a week and a half and had taken a few days off from school. After a thorough evaluation, Fisher concluded she had already rested and recovered enough and that she could — and should — resume her normal activities.

Most kids should transition back to their normal activity levels one to three weeks after a concussion, Fisher said.

"Everyone needs to be on the same page," Grant added. "Coaches, parents and players all need to recognize the symptoms of concussion, and girls should be evaluated if there is any concern."

Stanford Medicine integrates research, medical education and health care at its three institutions - Stanford School of Medicine, Stanford Health Care, and Stanford Children's Health. For more information, please visit the Office of Communications website at

2022 ISSUE 1

Understanding the world within us

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