Background <p>Head injuries pose a major global health issue, especially among young adults in developing countries. Data on head trauma patterns in conflict situations is scarce, and computed tomography (CT) is the main imaging method for evaluating acute head injuries.</p> Objectives <p>This study aimed to assess the CT scan patterns of traumatic head injury among northern Ethiopian victims of war who were treated at the University of Gondar Comprehensive Specialized Hospital during the armed conflict in 2020 and 2021.</p> Methods <p>A cross-sectional study was conducted on 76 cases of traumatic head injury who underwent CT scans from November 1, 2020, to January 30, 2021, at the Department of Radiology. Data regarding age, sex, mechanism of injury, and CT scan findings were collected and analyzed.</p> Results <p>A total of 76 patients were assessed, with 73 (96.1%) being males and a male-to-female ratio of 24:1. Ages ranged from 19 to 48 years, with the most affected group being ≤ 29 years (44 or 57.9%). Common head injury mechanisms included bullets (50%), blunt trauma (26%), and blasts (21%). Abnormal CT findings were noted in 60 cases (78.95%), with the most common findings being skull fractures (64.5%), cerebral contusions (33%), and metallic foreign bodies (36%). Scalp and brain hematoma, presence of soft tissue foreign body, pneumocephalus, and subfalcine herniation exhibited a statistically significant correlation with bullet injuries (p-value &lt; 0.05).</p> Conclusion <p>This study found a high rate of abnormal CT scans mainly involving young males as the primary victims of traumatic head injuries in war-affected areas of Northern Ethiopia. The leading causes were bullet injuries, with common CT scan findings including skull fractures and cerebral contusions, many requiring immediate intervention. The high rate of abnormal CT scans in these patients underscores the need to improve access to CT scans in conflict-affected areas.</p> Graphical abstract <p></p>