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Skiing and snowboarding are popular winter activities.1Estimates from numerous countries indicate that headinjuries account for 9 % to 19%, and neck injuries for 1 % to 4%, of all injuries reported by ski patrols and emer-gency departments.2–11 Rates of head and neck injuries have been reported between 0.09 and 0.46 per 1000 outings.12 Head and neck injuries are disproportionately represented in cases of severe trauma, and traumatic brain injury is the leading cause of death and serious injury among skiers and snow-boarders.13 As far back as 1983, Oh and Schmid recom-mended mandatory helmet use for children while skiing.14 Many studies of the relation between helmet use and head injuries among skiers and snowboarders have found a protec-tive effect.15–24 It has been suggested that the use of helmets may increase the risk of neck injury in a crash or fall.25 This may be more evident among children because they have a greater head:body ratio than adults, and the additional size and weight of the helmet may increase the risk of neck injury in an otherwise routine fall.26 We conducted a systematic review of the effect of helmets on head and neck injuries among skiers and snowboarders. Method