Objectives Despite of continuous development of occupational safety, there is still an excess of work-related head injuries. Prevention of head injuries can be promoted by evaluating risks and pathways of events preceding injuries.

Methods In Finland, more than 90% of employees are insured with inclusive mandatory coverage. Data on occupational head injuries in 2010–2017 was obtained from a workers’ compensation insurer database. European Statistics on Accidents at Work (ESAW) variables represented the conditions of the accidents and characteristics of the injury. Risk factors, contributing events, and injury mechanisms in 20 industry sectors, based on the Statistical classification of economic activities in the European community (NACE) were analysed.

Results Among the 32,898 cases, the most common area affected was eyes (49.6%), followed by brain and cranial nerves and vessels (21.0%). The highest incidence of head injuries was in construction (15.7 per 1,000 insurance years). Construction, manufacturing, and human health and social work activities stood out by their distinctive ESAW category counts. ‘Working with hand-held tools’ (odds ratio [OR] 2.99, 95% confidence interval [CI] 2.81–3.18) in construction and ‘operating machine’ (OR 3.58, 95% CI 3.22–3.98) and ‘working with hand-held tools’ (2.52, 2.37–2.67) in manufacturing predicted head injury. There were over tenfold increased risk related to parameters of violence and threat in health and social work activities.

Conclusions Risks and pathways preceding head injuries varied considerably in the 20 industry sectors. The highest head injury rates were in construction and manufacturing. Violence emerged as a major risk factor in human health and social work activities.