Mild traumatic brain injury (mTBI) or concussion in sports and recreation activities affects an estimated 1.6 to 3.8 million Americans each year [1]. When examining injury rates across sports, males are more likely to sustain SRC annually [2]. However, when considering sex differences in incidence of concussion, female athletes experience concussion at higher rates than males in comparable sports (e.g., basketball, hockey, soccer, lacrosse) 2, 3, 4.

Females can experience unique mechanisms of injury, symptom constellations and social and psychological consequences of concussion when compared to their male counterparts. However, the research to fully understand these differences is lacking. In the CDC's most recent Report to Congress on Traumatic Brain Injury in the United States: Epidemiology and Rehabilitation [5] there is no mention of sex differences in TBI in the general document, nor are sex differences referenced in sections on “Factors Influencing Outcomes” or “Unique Considerations for Specific Populations.”

A more recent review of sport-related concussions showed that only 19% of subjects identified in major concussion consensus papers were female and that 40.4% of these studies had no female representation at all [6]. As mounting evidence demonstrates, sex related differences in concussion mechanisms of injury, symptoms, recovery trajectory and outcomes, the inclusion of female participants in concussion research and literature requires a call to action. This article will summarize our current understanding of sex differences in epidemiology, symptom presentation and treatment of concussion, and identify gaps in knowledge and areas of future research.