To provide detailed epidemiological data on situations with a propensity of head injuries due to heading in professional football. In a prospective cohort study including the four highest professional football leagues in Germany, headers carried out in 1244 official matches and critical situations (CI) with a potential risk for injuries over one season were assessed by video analysis and a standardised video protocol. Results: 154,766 headers in 111,960 match minutes were recorded (1.4 headings/min). Video analysis showed a mean of 6.2 headers per field player and match (SD: 2,9; min: 0; max: 19) in the entire study population with a peak in the third league (7.1 per player and match). Headers were predominantly carried out with the forehead (78.5%), and nearly two-thirds occurred during defence (64.3%). 49.9% of all headers occurred during tackling, of which 78.3% involved body contact with an opponent. Video analysis yielded 848 CI. 74.5% of all critical incidents occurred during heading duels as a part of tackling (odds ratio: 3.6, 95%-CI: 2.4-5.2), and 99.4% involved body contact (odds ratio: 5.9, 95%-CI: 2,8-12,7). This study is the first to provide detailed epidemiological data on heading and critical incidences with high risk for head injuries in professional football. Heading duels bear a high risk of head injury and thus represent a key target for prevention strategies. The impacts of headers should be critically investigated regarding neurological consequences in further studies, by including the mean heading rate per mal field player and match.
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