The multi-center study presented reveals that 76% of the conventionally performed X-ray investigations of the skull can be avoided without any relevance concerning the non-diagnosis of severe injuries. Only in 3.2% of all patients investigated a skull X-ray had instantaneous therapeutically consequences. Thus routinely performed skull X-rays are no longer acceptable in the light of cost reduction and radiation load. The clinical-neurological investigations however are inevitable to perform the state of the art treatment of patients with head injuries today, leading to computerized tomography if necessary. A check-list of clinical findings is presented to get the indications for conventional X-rays of the skull and to manage an effective use of such investigations in appropriate clinical situations.