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Ask the Experts: Brain Injury

Lipton, Michael M.D., Ph.D.

doi: 10.1097/01.NNN.0000433484.02012.a5
Departments: Your Questions Answered

Does heading the ball in soccer damage the brain?

Michael L. Lipton, M.D., Ph.D., Fellow of the American College of Radiology, is associate director of the Gruss Magnetic Resonance Research Center at Albert Einstein College of Medicine and Director of MRI Services at Montefiore Medical Center, both in Bronx, NY.


Go to to watch a video interview with Dr. Gary Gronseth about the American Academy of Neurology's new guideline on concussion in sports.

Q Does heading the ball in soccer damage the brain?




A In some cases where the ball travels at high speed, heading the soccer ball can cause concussion, which is a mild form of traumatic brain injury (TBI). Concussion is diagnosed when symptoms—such as confusion, disorientation, amnesia, dizziness, headache, and others—accompany a blow to the head. Most people recover fully from a concussion over days to weeks, although some may have persistent symptoms. These can include problems with cognitive function, such as thinking and remembering.

Studies of the link between soccer heading and cognitive function (such as memory, attention, and information processing speed) have had mixed results. Some experts have looked at the studies and argued that heading is in fact associated with poorer cognitive function in soccer players at the high school, adult-amateur, and professional levels. However, many of these studies combine heading the ball with other causes of head injury, such as colliding with another player or the goalpost, or hitting the ground. As a result, the role of heading alone, without recognized concussion, remains unclear and controversial, as noted in the American Academy of Neurology's 2013 guideline update on concussion in sports (

In a 2013 paper published in Radiology, we reported a preliminary study that suggests excessive heading (more than a threshold of 885 to 1,550 times during the previous year, measured using a validated questionnaire) leads to changes in the brain and in cognitive function similar to those seen in people with concussion, even when the players have never experienced an actual concussion. Players reporting less heading were relatively unlikely to have changes in brain structure or cognitive performance (compared with those reporting above the threshold identified).

These results suggest that heading may be generally safe within limits. However, this is a preliminary study of a relatively small number of players. Thus, no specific recommendations can be made yet. For this reason, we are starting two large studies of heading in amateur soccer players to better understand the effects of heading. These studies will look at the brain with magnetic resonance imaging (MRI) as well as detailed measurements of cognitive function and concussion-related symptoms. If you are in the New York City area and are interested in joining the study, please email

© 2013 American Academy of Neurology