Teenage athletes disproportionately estimate their recovery from concussions on physical symptoms like headache and nausea, according to a new study from UPMC.

The UPMC Center for Sports Medicine Concussion Program studied 101 concussed teen athletes to find that they often overlook non-physical symptoms like emotional distress, sleep problems, and difficulty in concentration when they are gauging their recoveries.

“They are looking at, ‘Do I have a headache? Do I feel sick to my stomach?’ as their main criterion for determining if they’re normal, whereas clinicians, we know that the injury goes well far and above those two symptoms, and physical symptoms in general,” said UPMC Concussion Program Director Dr. Micky Collins.

The researchers recommended that sports medicine practicioners seek medical testing before sending any teen athlete back onto the field. According to Collins, that’s precisely the mandate of a state law to take effect July 1 this year.

Additionally, the study found that males tended to feel more “recovered” from their concussions than females, which Collins said may be attributed to a number of factors.

“Such as decreased neck strength; we think there may be some hormonal things going on. Migraine is four to six times more common in females and migraine is likely the strongest risk factor for poor outcome following a concussion,” said Collins. “We’re not sure if the males are actually better in recovering more quickly, or if they’re minimizing their symptoms more than the females, but we’re finding the females to be reporting more difficulties.”