Head injury (HI) is one of the common external causes of trauma-related mortality among young people in the world. The incidence of HI differs from one region to another according to socio-economic and geographical factors. Given this, the present study aimed to investigate the epidemiological characteristics and spatiotemporal patterns of HI in northwest Iran. This was a cross-sectional and geospatial study conducted in Zanjan province, Iran. We collected data on patients discharged with ICD-10 code S02 from 2014 to 2018. Global Moran's I, Hotspot analysis, Local Moran's I, and Emerging hotspot analysis tools were used to explore the spatial patterns. The ASR in the 5 years was 429 per 100,000, which was significantly higher among men. The spatial incidence distribution was clustered in total and among men. The east and southwest areas had the highest ASR, and different hot and cold spots were identified among genders. This study highlighted high-risk areas for HI incidence and showed that spatial analysis is a reliable approach for investigating the geographical distribution of diseases, and a significant tool for public health policymakers to improve decision-making by identifying the target points for implementing tailored and nuanced interventions and prevention programs.