<p>Dual-energy computed tomography (DECT) has been widely used in acute clinical settings to add diagnostic confidence and accuracy in head and neck imaging. Given the complexity of the head and neck anatomy, delayed or inaccurate diagnosis of abnormalities involving the head and neck region can result in poor outcomes and possibly life-threatening consequences. This article aims to familiarize radiologists with the clinical applications and limitations of DECT in emergency head and neck imaging to maintain interpretative accuracy and improve patients’ outcomes. Here, we demonstrate the profound capabilities of DECT for detecting and characterizing pathologies in the head and neck region with its superior abilities to differentiate materials, improve contrast enhancement, and reduce beam hardening artifacts. The robust imaging protocols and diverse post-processing algorithms of DECT enable radiologists to make diagnoses more quickly and accurately while accounting for suboptimal imaging from poor contrast opacification and/or beam hardening artifacts, unexpected pathologies, and reduction of unnecessary additional studies, and therefore, reduction of radiation dose and improvement of workflow in the emergency setting.</p> Graphical abstract <p></p>