Ice hockey is one of the fastest and roughest of all sports. Based on prospective injuries reports of the North American National Hockey League, the Canadian Amateur Hockey Association and three European teams (USSR, Sweden and Switzerland) the patterns, topography, circumstances and sequelae of the head injuries related to ice hockey are described. Although mandatory helmets and face masks have reduced the large number of facial and eye injuries, the rates of head injury and concussion are still to high. A number of steps must be taken by the hockey organisations, players, equipment manufacturers and health-care professionals to prevent injuries for specific prevention of head, face and eye injuries the rules should be strictly enforced, e.g. no checks from behind, high-sticking penalties, and mandatory helmets with face masks.