Background: To evaluate the natural history of patients with metastatic squamous cell carcinoma (SCCA) of the head and neck to the brain. Methods: A retrospective review of patients with brain metastases treated over a 20-year period identified five that had a head and neck SCCA primary. Results: Five cases of patients with SCCA of the head and neck that developed brain metastases are presented in detail. Conclusion: In patients with aggressive disease, large infiltrative lesions, and in late survivors with initially advanced disease, metastasis to the brain should be considered. Perineural metastasis appears to be the most common mode of spread of head and neck SCCA to the brain. Pain, paresis, or paresthesias in the distribution of cranial nerves or other neurological symptoms should alert the otolaryngologist to neural or central nervous system involvement in patients with SCCA of the head and neck. Surgery with or without post-operative whole brain radiation therapy is the mainstay of treatment in most patients. Stereotactic radiosurgery may play a major role in treating brain metastases from head and neck primary tumors. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.