Heading and the brain – what do we know?

There is currently no evidence showing that heading a football has a negative impact on long-term cognitive function and brain health.

The possible long terms effects of playing sport on the brain are again in the media. Some of this has been driven by the recent publication of a study that has examined the brains of former American Football players.1 This study has found that most of these brains have evidence of chronic traumatic encephalopathy (CTE). Almost all of the brains from retired NFL players (111/112 players) were affected.

One of the main issues with this study is selection bias – the brains were all donated by players who had developed cognitive issues and were concerned that they had CTE. It is the authors belief that the damage is related to accumulated trauma from repeated blows to the head – and not just the cumulative effects of concussion. It is not clear whether the findings would have been different had it been possible to select a random sample of subjects. While the study is clearly thought-provoking it is unclear about what significance this has in football.

In football it has been suggested that heading the ball might be associated with longer-term cognitive dysfunction. This is currently speculation only with no evidence to demonstrate this relationship. This is highlighted by the recent publication of a systematic review and meta-analysis which examined the effects of football heading on the brain.2 A total of 467 unique studies were identified (with only 28 studies meeting the selection criteria). The meta-analysis included a total of 2288 participants (933 female participants and 1355 male participants) aged 13–70 years. This analysis found no association.

Clearly there is still much to learn about the longer-term implications of sport-related concussion and head injuries on the brain. At present however there is no evidence to suggest that heading the ball is unsafe.

To learn more about the assessment and management of concussion (and other head injuries) complete the concussion modules in the FIFA Diploma in Football Medicine.


1 Mez J, Daneshvar DH, Kiernan PT et al. Clinicopathological Evaluation of Chronic Traumatic Encephalopathy in Players of American Football. JAMA. 2017;318(4):360-370

2 Kontos AP, Braithwaite R, Chrisman SPD et al. Systematic review and meta-analysis of the effects of football heading. Br J Sports Med 2017;51:1118-1124.


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Dr VOUNDI VOUNDI JuniorBangoura Recent comment authors
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Les trauma crâniens avec ou sans perte de connaissance doivent être pris au sérieux les lésions traumatiques sont l apanage des disciplines sportives Pour le cas particulier du foot ball c est des micro trauma crâniens non ou mal traités qui sont à l origine des cas les plus sérieux après la retraite de ces sportifs L usage du scanner nous permet de diagnostiquer à temps et envisager un traitement adequoit Dans les pays pauvres ou la prise en charge semble être difficile le pronostic n es pas favorable et la majeur partie de ses anciens sportifs finissent dans un… Read more »

Voundi Voundi Junior
Voundi Voundi Junior

Absolument d’accord. Mais la difficulté diagnostique de ces micro lésions (encéphalopathie traumatique chronique par exemple) est un problème majeur vu que pour la plus part des cas ont été diagnostiqués en post-mortem en paraclinique, déjà qu’en clinique on ne retrouve que des sydromes tels que le syndrome frontal, ou des signes tels que les troubles du comportement, de l’attention, de la concentration, atteinte des fonctions supérieurs, et autres qui peuvent aussi être attribués à d’autres pathologies du systême nerveux central. Et le retard d’apparition des ces signes annonciateur, témoigne encore plus de la chronicité de l’atteinte du cerveau. En tant… Read more »

Dr Aniemena-George Chidi Chinenye
Dr Aniemena-George Chidi Chinenye

This long debate is highly a misnomer, I have seen players head the ball and had concussion. whether it was the ball striking the head or the head striking the ball, it was traumatic. I personally think ball pressure,( that is to say how hard or relatively soft the ball feels) is a major factor, not every team plays with the standard FIFA ball. With the definition of concussion, a ball could travelling at a high velocity could cause concussion. Moreover, if heading another players head or elbow can cause concussion, in simple principle why not the ball. weight, air… Read more »

Sajida Fajar

If heading the ball is one of the major cause of concussion in football players then FIFA should find other alternatives of tackling the ball and some kind of legislative work must be done regarding the headshots so that all forms of TBI must be prevented.