OBJECTIVE: To investigate the rate of and risk factors for head and neck injury in male soccer. DESIGN: Prospective cohort study. SETTING: Professional soccer. PARTICIPANTS: Twenty-six European teams between 2001/2002 and 2009/2010. ASSESSMENT OF RISK FACTORS: Simple and multiple risk factor analyses were evaluated using Cox regression for player-related variables and logistic regression for match-related variables. MAIN OUTCOME MEASURES: Injury rate (number of time loss injuries per 1000 hours). RESULTS: A total of 136 head and neck injuries were recorded (2.2% of all injuries). The head and neck injury rate was 0.17 (0.06 concussions) per 1000 hours. There was a 20-fold higher rate of head and neck injury during match play compared with training (rate ratio [RR], 20.2; 95% confidence interval [CI], 13.3-30.6) and a 78-fold higher rate of concussions (RR, 78.5; 95% CI, 24.4-252.5). Mean layoff for concussion was 10.5 days, but 27% of the concussed players returned to play within 5 days. Defender was the only significant player-related risk factor for head and neck injuries in the multiple analysis (RR, 1.8; 95% CI, 1.0-3.1), whereas no significant variables were identified for concussions. CONCLUSIONS: Head and neck injuries were relatively uncommon in professional soccer. Defender was the playing position most at risk. More than one-quarter of the concussed players returned to play before what is recommended in the consensus statements by the major sports governing bodies.