Objective Despite the continuous development of occupational safety, the prevalence of work-related head injuries is excessive. To promote prevention, we conducted a study evaluating the risks and pathways that precede head injuries in different economic activity sectors. Methods In Finland, more than 90% of employees are covered by inclusive statutory workers’ compensation. We obtained data on occupational head injuries in 2010–2017 from an insurance company database. The European Statistics on Accidents at Work (ESAW) variables represented the characteristics of the accidents and the injury. We analysed the risk factors, contributing events and injury mechanisms in 20 industry sectors, based on the Statistical Classification of Economic Activities in the European Community (NACE). Results In the 32,898 cases, the most commonly affected area was the eyes (49.6%). The highest incidence of head injuries was in construction (15.7 per 1000 insurance years). Construction, manufacturing, and human health and social work activities stood out due to their distinctive ESAW category counts. ‘Working with hand-held tools’ [risk ratio (RR) 2.23, 95% confidence interval (CI) 2.14–2.32] in construction and ‘operating machines’ (RR 3.32, 95% CI 3.01–3.66) and ‘working with hand-held tools’ (1.99, 1.91–2.07) in manufacturing predicted head injury. The risk related to parameters of violence and threats in health and social work activities was nearly ninefold the risk of other sectors. Conclusion The risks and pathways preceding head injuries varied considerably. The highest head injury rates were in construction and manufacturing. Violence emerged as a major risk factor in human health and social work activities.

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