The Hidden Risks of Heading: What Research Reveals About Brain Damage in Football
The conversation around brain health and damage in football has never been louder. With growing evidence of the dangers linked to repetitive head impacts, researchers are uncovering what prolonged exposure to heading can mean for players long after their careers end. Recent studies, led by neurologist Suzan van Amerongen, highlight both the risks and the urgent need for change.
The Case That Sparked Dutch Research
The debate in the Netherlands gained momentum after the case of Wout Holverda, a former Sparta striker famous for his heading ability, who later developed early-onset dementia. After his death in 2021, examination of his brain revealed abnormalities consistent with CTE (Chronic Traumatic Encephalopathy) — a degenerative disease also found in American football players and boxers.
“His case was an inspiration,” van Amerongen explains. “We were able to exclude many other causes for his dementia. The evidence pointed towards all the head impacts he sustained throughout his career.”
Heading and Cumulative Risk
The danger, research shows, is not limited to concussions. Instead, it is the accumulation of small, often unnoticed impacts over time that triggers progressive brain damage.
“It’s not only the big traumatic events that matter,” van Amerongen stresses. “The small impacts you don’t feel — the ones that happen every time you head the ball — those can add up and lead to problems later in life.”
While some argue that stronger neck muscles or better technique can prevent harm, she disagrees. “Technique may prevent acute symptoms, but it doesn’t protect you from the long-term consequences. The brain still moves inside the skull. In the end, it’s about exposure. The more impacts, the bigger the risk.”
Who Is Most at Risk?
Research in Scotland revealed that strikers and defenders, who head the ball most, were more likely to develop dementia than goalkeepers. Gender differences remain unclear. “For female players, the data is still very limited,” van Amerongen says. “We’ll probably only know more in a couple of decades as their exposure grows.”
Football vs. Other Contact Sports
Compared to rugby or American football, football may carry slightly lower risks due to lighter impacts. But frequency remains an issue. “The collisions in American football are bigger, but heading in football happens more often. That’s what makes it concerning,” van Amerongen notes.
Cases of CTE have been found in both professional and amateur players. “It shows that you don’t need a career at the very top to face these risks,” she adds.
Prevention Over Protection
Protective headgear, often discussed as a solution, offers limited benefits. “Helmets may prevent fractures, but they don’t stop the brain from moving inside the skull,” van Amerongen explains. “They won’t reduce the risk of long-term consequences like CTE.”
Instead, her research points to education and regulation. “Many athletes told us they were never informed about the risks,” she says. “That has to change. We should at least limit heading in training. For children, I think we should prevent heading altogether. Why expose them unnecessarily when it’s not needed for their development?”
Progress and Hope
Football has improved in handling concussions, but awareness of long-term effects remains low. “Decades ago, players who were completely disoriented after a header just kept playing,” van Amerongen says. “Now there’s more attention, which is progress. But preventing concussions doesn’t necessarily mean preventing CTE.”
Looking forward, she is hopeful about new tools to detect CTE earlier. “Right now, diagnosis is only possible after death. But we’re working on biomarkers and scans that may allow us to identify it during life. That would be a breakthrough.”
Her main concern is the lack of participation in research. “Boxers are often more willing to take part because they understand the risks of their sport. In football, many players prefer to ignore it. That makes advancing our research more difficult.”
A Message to the Next Generation
If she could give one piece of advice to young players, parents, and coaches, it would be simple: use common sense.
“Even though we can’t explain everything yet, why expose children to unnecessary risks?” van Amerongen says. “They don’t need to head the ball at an early age. Focus on skills, fun, and safety first. That way, the game can still be beautiful — without the hidden cost.”
Ready for more?
Brain safety is just one part of football’s wider wellbeing conversation. Read our feature on the PFA Neurodiversity Study and how it sheds light on mental health in the game
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