Objectives <p>Traumatic brain injury (TBI) is a major cause of long-term neurological disability worldwide, ranging from minor injuries to severe forms with permanent impairment. We assessed levels, trends, and future projections of TBI burden across the Americas.</p> Methods <p>Using Global Burden of Disease (GBD) 2023 estimates, we analyzed TBI incidence, prevalence, and years lived with disability (YLDs) by severity, age, sex, Socio-demographic Index (SDI), and cause from 1990 to 2023. Age-standardized rates and estimated annual percentage changes were calculated. Decomposition analysis quantified the contributions of population growth, aging, and epidemiological change. Projections were generated through 2050.</p> Results <p>TBI burden varied substantially across regions, with minor TBI accounting for most cases in all settings. Central and Tropical Latin America had the largest absolute burden of both minor and moderate-to-severe TBI but showed sustained declines. High-income North America retained the highest age-standardized burden, particularly for minor TBI and among males. Burden increased with age and remained higher in males than females. Since 1990, changes in total TBI burden were driven mainly by population growth and aging. Falls were the leading cause of TBI across all SDI levels. Projections to 2050 showed modest regional divergence, with persistently high minor TBI burden in high-income North America and gradual increases in Southern and Andean Latin America.</p> Conclusion <p>TBI burden in the Americas remains substantial and uneven, largely shaped by demographic change and persistent regional and sex disparities, highlighting the need for targeted prevention and long-term care planning.</p> Clinical trial registration <p>Not applicable.</p>