Fatal head injury is a major public health problem causing significant morbidity and mortality worldwide with road traffic accident being the major cause of head injury. This is particularly so in developing countries such as Nigeria where the commonest form of transportation is by road. This is a retrospective study of all cases of fatal head injuries seen at autopsy in the Department of Pathology and Forensic Medicine of the Lagos State University Teaching Hospital (LASUTH) over a 5-year period spanning January 2007 to December 2011. The study is designed to analyse the pattern of fatal head injuries among the autopsies performed in Lagos LASUTH. In addition, the study also aimed at ascertaining the causes of death, causes of fatal head injury, prevalence of head injury and to determine the age and sex prevalence of fatal head injury. Materials were derived from the autopsy registers, computer records, post-mortem reports, coroners’ papers and hospital records. Analysis of the data obtained was done by the use of Statistical Package for Social Science (SPSS) version 17. Head injuries accounted for 950 (13.8%) of the 6,884 autopsies performed during the study period and the age of victims range from <1 year to 86 years (mean = 36.07). The male to female ratio is 5.6:1; the average age of females (35 years) is less than that of males (48 years) and the highest incidence in both male and female victims occurred between 20-49 years. Road traffic accident accounts for 68.9% of the cases while assault, firearms and falls from a height account for 13.7%, 9.7%, and 4.6% respectively. Severe craniocerebral injury (32.7%) was the commonest cause of death followed by multiple injuries (29.7%) and intracranial haemorrhage 2 (26.8%). Intracranial haemorrhages at autopsy were subdural (74.3%), subarachnoid (67.5%), epidural (26.1%), intracerebral (14.0%) and intraventricular (3.5%). Skull fractures occurred in 84.1% of the victims and fractures involving the vault are much more common compared with those involving the base of the skull. Temporal bone (35.9%) and the middle cranial fossa (23.5%) fractures are the commonest for vault and base respectively. The chest is the most injured extracranial site in this study. In conclusion, this study has shown that young people especially the economically productive males are predominantly affected by fatal head injuries. Based on the findings, fatal head injuries could be reduced if government at all levels adhere to international best practice regarding road transportation as it constitutes a major cause of fatal head injuries. Key words: Head injuries, Road traffic accident, Severe craniocerebral injury, Intracranial haemorrhage, Skull fracture, LASUTH