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 / Updated By Maggie Fox 
 
 Women’s brains appear to be more affected by heading a soccer ball than men’s are, new research shows. 
 
 A study using brain scans shows distinct patterns of damage in the brains of female soccer players compared with male players. And women in general had more of their brain matter affected, the researchers reported Tuesday in the journal Radiology. 
 
 That doesn’t necessarily translate into symptoms. None of the women in the study had any more symptoms than the men did, said the team at Albert Einstein College of Medicine in New York. 
 
 But it may help explain why other studies have shown that female soccer players are more likely to report symptoms of concussion than male players are. 
 
 “Researchers and clinicians have long noticed that women fare worse following head injury than men, but some have said that’s only because women are more willing to report symptoms,” Dr. Michael Lipton, a professor of radiology and psychiatry at Albert Einstein who led the study team, said in a statement. 
 
 And much of the diagnosis of brain injury is subjective, relying on what people say they are experiencing. 
 
 Brain scans get past that problem, Lipton said. 
 
 “Based on our study, which measured objective changes in brain tissue rather than self-reported symptoms, women do seem more likely than men to suffer brain trauma from heading soccer balls,” he said. 
 
 Lipton’s team studied 49 men and 49 women who all played in amateur soccer leagues. None had any evidence of head injury. 
 
 “Participants were asked how often they headed the ball on average during each type of session (practice vs. competition) and in each setting (indoor vs. outdoor), how many times per week they participated in each, and how many months per year they played soccer,” the researchers wrote in their report. 
 
 Then the volunteers got a specialized type of magnetic resonance imaging scan called diffusion tensor imaging. It can show damage to tissue on a very fine scale. 
 
 The women who headed more often had eight brain regions that showed damage, while men had three main regions of damage. And more overall brain area tended to be damaged in the women than in the men. 
 
 “The fivefold greater volume of affected white matter that we identified in women compared with men pointed to a higher burden of microstructural consequences in female headers,” they wrote. 
 
 “Our findings add to a growing body of evidence that men and women express distinct biologic responses to brain injury.” 
 
 It is unclear why, but researchers have pointed out that women have smaller necks than men, which could cause the head to move differently, perhaps shaking and damaging the brain in different ways. 
 
 There is no debate that heading the ball can cause brain injury. A 2015 study of high school soccer players published in the Journal of the American Medical Association found that heading accounted for 30 percent of concussions in male players and 25 percent of those in girls. 
 
 Among adults, as well, heading the ball only accounts for a portion of concussions. Players are also often kicked, slammed to the ground, and whiplashed in the fast-moving game. 
 
 It’s important to be able to identify the damage early, said Lipton. Football players, combat veterans and others often suffer a degenerative brain disease called chronic traumatic encephalopathy. There’s no cure for it and concussions appear to be strongly involved. 
 
 “In various brain injuries, including chronic traumatic encephalopathy, subclinical pathology develops before we can detect brain damage that affects function,” Lipton said. 
 
 “So before serious dysfunction occurs, it’s wise to identify risk factors for cumulative brain injury — such as heading if you’re female — so that people can act to prevent further damage and maximize recovery.” 
 
 Heading may not necessarily need to be banned, he said. 
 
 “We have carried out several studies showing that most players seem to tolerate some level of heading,” Lipton said. 
 
 “Limiting the number of headers allowed in soccer might have similar benefits in preventing head injuries. But we can’t recommend specific numbers at this point. Fully understanding the risk of heading will take a lot more work.” ||||| Repeatedly heading a soccer ball exacts a toll on an athlete’s brain. But this cost—measured by the volume of brain cells damaged—is five times greater for women than for men, new research suggests. 
 
 The study provides a biological explanation for why women report more severe symptoms and longer recovery times than men following brain injuries in sports. Previously some researchers had dismissed female players’ complaints because there was little physiological evidence for the disparity, says Michael Lipton, a neuroscientist at the Albert Einstein College of Medicine and a co-author of the paper. 
 
 Lipton’s team used magnetic resonance imaging to peer into the skulls of 98 adult amateur soccer players—half of them female and half male—who headed the ball with varying frequency during the prior year. For women, eight of the brain’s signal-carrying white matter regions showed structural deterioration, compared with just three such regions in men (damage increased with the number of reported headers). Furthermore, female athletes in the study suffered damage to an average of about 2,100 cubic millimeters of brain tissue, compared with an average of just 400 cubic millimeters in the male athletes. 
 
 Lipton does not yet know the cause of these sex differences, but he notes two possibilities. Women may suffer stronger whiplash from a cranial blow because they generally have less muscle mass than men to stabilize the neck and skull. Alternatively, a dip in progesterone, a hormone that protects against swelling in the brain, could heighten women’s vulnerability to brain injury during certain phases of their menstrual cycle. 
 
 Thomas Kaminski, a sports physiologist at the University of Delaware, who was not involved in the work, calls it “truly groundbreaking.” The research is unique in highlighting the cumulative effect of repetitive knocks on the skull, as opposed to major traumatic injuries, he says. “Very few of these subjects had a history of concussion.” 
 
 Researchers are now eager to determine if these white matter changes carry long-term cognitive consequences. Until more is known, Kaminski advocates a proactive approach to limiting the damage caused by headers. In August he met with U.S. Soccer Federation officials to craft science-based guidelines for practicing the move in youth leagues. 
 
 Carla Garcia, a participant in Lipton’s study, says that after 47 years of playing soccer, she has no plans to quit using her head. But she notes, “If there’s any way we can make the sport safer for children, that’s important.” ||||| Heading May Be Riskier For Female Soccer Players Than Males 
 
 Enlarge this image toggle caption Krista Long/Getty Images Krista Long/Getty Images 
 
 The first rule of soccer is pretty obvious: don't use your hands. But soccer's signature move, heading the ball, can cause a detectable impact on players' brains. And according to a study published Tuesday in Radiology, female players are more sensitive to the impact than males. 
 
 The study authors found that female amateur soccer players who frequently head balls showed more white matter brain alterations than their male counterparts. The study included 49 women and 49 men, ages 18 to 50, and examined MRI imaging of players' brains. Each female player was compared to a male player of a similar age and with other similar characteristics including frequency of heading exposure. 
 
 Lead author Michael Lipton, a neuroradiologist and neuroscientist at Albert Einstein College of Medicine, says white matter in the brain can be compared to fiber optic cable, which connects a network of computer. White matter is made up thread-like axon nerve fibers that connect neurons to each other, and their protective covering, myelin. 
 
 Heading causes these brain tissues to become disorganized, Lipton says. His previous research found that these abnormalities accompany poorer cognitive function associated with memory or attention issues when associated with heading. 
 
 "The most important finding here is that we see that in women's brains, actually looking at brain tissue, there seems to be a greater sensitivity to repetitive, very low-level injury relative to men," he says. 
 
 An important note about this research, Lipton says, is that it isn't about concussions. Instead, it's measuring "sub-concussive injuries," or repeated impacts that don't cause any immediate, acknowledged problem for the player, but could be problematic in the long-term. 
 
 "It's actually more important to define what's happening in people that are not yet symptomatic, because that's where there's still an opportunity to head off long-term problems," he says. 
 
 It's already known that female soccer players are at a higher risk of concussion than males. Wellington Hsu, a professor of orthopedic surgery at Northwestern University, led a decade-long study of injuries among high school athletes that found this. 
 
 But the current study gives additional evidence that women are more susceptible to the impact of heading, and shows more areas of women's brains are susceptible to potential injury than men's. 
 
 Hsu, who was not involved in the current study, says while it's not possible to draw firm conclusions from the study alone, it suggests a path forward for making the sport safer. 
 
 "What I think this paper may lead to is further research in the preventative mechanisms of concussions, whether or not it's a brace or a helmet or heading technique or a different way we think about this in men and women," Hsu says. 
 
 Women are more likely to report concussion-related symptoms than men, but Lipton says there has been debate over whether women actually are more sensitive or just more likely to speak up. 
 
 This study confirms that there are changes in the tissue of women's brains after these repetitive hits from the soccer ball that are different from men in a similar situation. 
 
 "This is the first time anybody has put a definitive piece of information behind what has been a contentious dispute as to whether women's brains are intrinsically more sensitive, or whether it's an artifact of reporting of symptoms," Lipton says. 
 
 It's unclear why women more biologically likely to be affected by repetitive heading. Lipton says it could have to do with sex hormones, or with the fact that women typically having less body and muscle mass than their male counterparts. 
 
 Thomas Kaminski, a professor of kinesiology and applied physiology at the University of Delaware, who was not involved in the study, says that the differences in these changes in the brain could have to do with neck strength. Women typically have weaker necks and smaller heads than men. 
 
 Does this research mean women should hang up their cleats forever? Probably not, says Lipton. There are a lot of brain health benefits to getting active, and women are actually okay to head the ball up to a certain point. 
 
 "We're not saying that you head the ball and then you're brain injured," Lipton says. "The data consistently shows that there seems to be some level of exposure to these repeated impacts which is pretty well tolerated by most people. It's really a matter of figuring out how much is too much." 
 
 Lipton says he hopes to find out if there's a safe threshold on heading impact for women. The latest FIFA data shows 265 million people play soccer across the globe, and Lipton says, adverse effects when multiplied by that many people "potentially [pose] a huge public health concern." 
 
 "The problem isn't that [soccer is] creating all kinds of vegetative, brain damaged people," he says. "But what's the potential benefit of athletics that's being given up by the effect of this kind of repeated head injury? And is there a way to strike a balance so that people can benefit maximally and not incur the adverse effects?" 
 
 Kaminski says it would be interesting to take this research one step forward and explore this problem in youth. In the U.S., youth players can start heading the ball at age 11. He thinks it's worth questioning whether that age cutoff should be older. Parents are faced with the issue of wanting their kids to be active but safe at the same time, he says. 
 
 "What happens if [children] head the ball ten times, or a hundred times?" he says. "Would you see these changes? Those are the big question marks I have." 
 
 Carla Garcia, a Brooklyn resident and participant in the study, has been playing soccer since she was five. Now 52, she says these results probably won't change the way she plays, but if she were younger, she would consider heading the ball a bit less. She joined the study as a way to give back to the sport she loves — and she even wants to donate her brain to science to help researchers understand brain injuries. 
 
 "I think it probably over the long term will have an effect on the way that younger women and younger people play, and I got involved for that reason," she says. "I thought that Dr. Lipton and his colleagues could find the way to make it safer for kids to play." 
 
 Sara Kiley Watson is NPR's Science desk intern.
– A new study suggests that girls and women who play soccer should think twice about going up for that next header. Research out of the Albert Einstein College of Medicine found that females were five times more likely than men to suffer damage to the brain, reports Scientific American. The study in Radiology compared 49 female and 49 male soccer players who used headers, and it discovered noticeably more deterioration in the white-matter regions of the women's brains. This kind of damage wouldn't necessarily translate into concussions on the field, but to more low-grade problems that could accumulate over time and possibly lead to cognitive issues, reports NPR. "The most important finding here is that we see that in women's brains, actually looking at brain tissue, there seems to be a greater sensitivity to repetitive, very low-level injury relative to men," says lead author Michael Lipton. The researchers didn't look into why the disparity exists, but they note that men generally have more muscles in the neck area, which could limit whiplash. It's also possible that women become more vulnerable during menstrual cycles because of a dip in the hormone progesterone, which guards against brain swelling. Lipton and his team aren't necessarily calling for headers to be banned, reports NBC News. "Most players seem to tolerate some level of heading," he says. The key now is figuring out those safe levels. (Brandy Chastain wants to help in the research.)