Purpose <p>Concussion is an inherent risk in Mixed Martial Arts (MMA), where head trauma often determines competitive success. This study investigated the impact of two extrinsic factors, cage size and audience presence, on the incidence of head trauma in MMA based on fights ending via knockout (KO) or technical knockout (TKO) to the head.</p> Methods <p>Data were collected across eight male weight classes under four conditions: small and big cages, with and without a live audience. Chi-square test examined the association between conditions and the percentage of fights ending via KO/TKO to the head for each weight class and a binary logistic regression assessed odds ratios of a combined KO/TKO to the head for each weight class in each condition.</p> Results <p>Non-adjusted results from bantamweight fights in a small cage were associated with higher frequency of KO/TKO to the head outcomes compared to a big cage ((X²(1), N = 248) = 11.58, <i>p</i> = 0.001, ϕ = 0.22), and 222% increased odds compared to a big cage with an audience (<i>p</i> = 0.001).</p> Conclusions <p>This hypothesis-generating study suggests that modifying cage size based on weight class may reduce head trauma risks in male fights. Further research on intrinsic and extrinsic factors, including training practices and individualized risk assessments, is essential to develop effective concussion prevention strategies and enhance athlete safety in MMA.</p>