Science Update: Females with a concussion more likely than males to have neck injury, NIH-funded study suggests

Woman standing in front of a two car crash, massaging the back of her neck, grimacing in pain.
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Women and girls with a concussion are more likely than males to have a neck injury, according to an analysis of emergency department visits funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The finding suggests that physicians evaluating females for concussion should also consider evaluating them for neck injury so that they can benefit from treatment as soon as possible.

The study was led by Angela Colantonio, Ph.D., of the University of Toronto. It appears in the Journal of Women’s Health.


Concussion is a mild form of traumatic brain injury, which occurs after a blow to the head. Concussions comprise about 75 percent of the roughly 3.5 million new traumatic brain injuries that occur in the United States each year, the study authors wrote. Because impact to the head may also affect the neck, concussion and neck injury commonly occur together. Whiplash—neck injury resulting from impact that causes the head to jerk forward or back—shares many symptoms with concussion, including headache, dizziness, memory loss, and impaired concentration and therefore might be missed when a patient is evaluated for concussion.

Previous studies have shown that women and girls have a higher risk for neck injury with traumatic brain injury. However, these studies included severe forms of traumatic brain injury, which were more likely to stress the neck than the milder injuries resulting in concussion. Women tend to have smaller neck bones and less muscle mass than men of comparable height, the authors stated, which possibly could place them at higher risk than males for neck injury after concussion. The authors undertook the current study to determine whether mild traumatic brain injury alone also conveyed a higher risk for neck injury in females.


Researchers reviewed emergency department records of all patients with a concussion in Ontario, Canada, from 2002 to 2012. Patients with more severe forms of traumatic brain injury were not included in the study. In addition to examining records from concussions resulting from all causes, they looked at concussions sustained from motor vehicle crashes and sports.

For concussions from all causes combined, females had a higher rate of neck injury than males: 4,333 per 100,000 women with concussions vs. 2,995 per 100,000 males with concussions. Women also were more likely to have a neck injury with concussions from motor vehicle crashes (11,978 vs. 8,759) and from sports (4,207 vs. 2,794).


Because neck injuries occurring with concussion have been linked to persistent post-concussion symptoms, physicians evaluating concussion patients, particularly female ones, may want to consider the possibility that they also have a neck injury, the study authors wrote.

Next Steps

The researchers noted that their findings suggest additional research is needed on how to prevent head and neck injuries, particularly in women and girls.


Sutton, M, et al. Neck injury comorbidity in concussion-related emergency department visits: a population-based study of sex differences across the life span. Journal of Women’s Health.2018. DOI: 10.1089/jwh.2018.7282.

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