Head injury is considered as a major health problem that is a frequent cause of death and disability and makes considerable demands on health services. A cross-sectional study was conducted to determine the etiological spectrum, injury characteristics and treatment outcome of head injury patients at Bugando Medical Centre (BMC) in North-western Tanzania. Data were collected using a pre-tested, coded questionnaire and analyzed using SPSS programme. A total of 260 head injury patients (mean age=26.84 years) were studied. Males outnumbered females by a ratio of 1.5:1. Road traffic accidents (RTAs) were the most common cause of injury accounting for 49.2% of patients. Scalp injuries, cerebral concussion and skull fractures were the most common type of head injuries. Fifty-six (21.5%) patients had associated injuries of which musculoskeletal region (36.1%) was commonly affected. Most of patients (66.1%) sustained mild head injury. The majority of patients (75.8%) were treated conservatively and only 24.2% of patients needed surgical interventions. Most of patients (85.4%) had good recovery. The mean hospital stay (LOS) was 24.56 days and the mortality rate was 11.2%. Patients who had RTAs, penetrating head injuries, associated long bone fractures and those who were treated surgically were found to have significantly longer LOS ( P < 0.001). Mortality was found to be significantly associated with extreme of age, presence of pre-morbid illness and associated injuries, admission Glasgow Coma Score < 9, systolic blood pressure < 90mmHg, injury severity core ≥16, longer duration of loss of consciousness, the need for intensive care unit admission and finding of space occupying lesion on computed tomography scan ( P < 0.001). Head injuries resulting from RTAs remain a major public health problem in this part of Tanzania. Urgent preventive measures targeting at reducing the occurrence of RTAs is necessary to reduce the incidence of head injuries in this region.