Heading the ball is a normal part of soccer, but new research suggests it may come with hidden costs to the brain.
Scientists at Columbia University and the Albert Einstein College of Medicine studied more than 350 amateur soccer players and found that frequent heading was linked to subtle brain changes in areas important for memory.
Repetitive soccer heading may cause brain changes
Repetitive head impacts from sports are under continuous scrutiny for their role in long-term brain changes and cognitive decline, even when no concussion has been diagnosed.
“While taking part in sports has many benefits, including possibly reducing the risk of cognitive decline, repetitive head impacts from contact sports like soccer may offset those potential benefits,” said corresponding author Dr. Michael L. Lipton, a professor of radiology at the Columbia University Irving Medical Center.
Many imaging studies in the past focused on deep white matter – the brain tissue buried beneath the cortex. These studies often ignored juxtacortical white matter, the layer just under the brain’s outer surface, especially within the folds (sulci). Biomechanical models and postmortem examinations suggest that juxtacortical white matter is especially vulnerable to stress from repeated minor head impacts. However, there is little in vivo evidence linking microstructural damage in this area to cognitive impairment.
Earlier work has hinted at there being associations between frequent heading and an altered brain structure or thinking skills. However, these studies often had small samples, imprecise estimates of heading exposure or they didn’t test cognition comprehensively.
The new study looks at whether repetitive heading in amateur players is associated with measurable microstructural changes in juxtacortical white matter in the sulci, and whether those changes mediate the link between head impact frequency and thinking or memory performance.
Sulcal white matter distrupted in soccer players
The study examined 352 active amateur soccer players, alongside 77 athletes from non-collision sports such as swimming and running. Soccer players were divided into four groups based on how often they headed the ball in the previous year. At the low end were players averaging just over 100 headers, while the highest group averaged more than 3,000.
All participants underwent brain imaging with diffusion MRI, which can detect microstructural changes in white matter. Players also completed computerized tests of verbal learning and memory.
Players who headed the ball more frequently had greater disruption in sulcal white matter, using measures that indicated reduced structural integrity. These effects were strongest in the temporal, orbitofrontal and parietal regions of the brain.
Cognitive testing revealed that worse memory and learning scores were linked to more disrupted white matter in these same regions.
“Our findings suggest that this layer of white matter in the folds of the brain is vulnerable to repeated trauma from heading and may be an important place to detect brain injury,” said Lipton.
In contrast, deep white matter showed little change.
Mediation analysis suggested that the structural changes partially explained the connection between heading frequency and cognitive performance, pointing to a biological pathway rather than a simple correlation.
Mediation analysis
Mediation analysis is a statistical method used to test whether the effect of one factor on an outcome is explained, at least in part, by a third factor.
What brain changes from soccer heading mean for athletes
The findings suggest that, even at the amateur level, frequent heading can alter brain structure in ways that affect memory and learning – challenging the assumption that only professional athletes are at risk.
“Our study found that people who experienced more impacts from headers had more disruptions within a specific layer in the folds of the brain, and that these disruptions were also linked to poorer performance on thinking and memory tests,” said Lipton.
If confirmed, imaging in the sulcal white matter could also help clinicians detect and monitor brain changes before symptoms escalate.
At the same time, the research has limitations. Estimates of heading frequency relied on self-reported recall, which can be unreliable, especially in a study where memory performance is also measured. The cognitive testing focused narrowly on verbal learning and memory, leaving other domains such as attention and executive function unexamined. Since participants were only scanned once, the study also cannot yet show whether these brain changes are permanent, progressive or reversible.
“More research is needed to further explore this relationship and develop approaches that could lead to early detection of sports-related head trauma,” said Lipton.
Reference: DeMessie B, Stewart WF, Lipton RB, et al. Soccer heading exposure–dependent microstructural injury at depths of Sulci in adult amateur players. Neurology. 2025. doi: 10.1212/WNL.0000000000214034
This article is a rework of a press release issued by the American Academy of Neurology. Material has been edited for length and content.