OBJECTIVES: To assess imaging and treatment patterns in head and neck cancer (HNC) patients using a large commercial-insurance database from the United States (U.S.). METHODS: We used the Marketscan®  Research Databases (2007-2011) to identify adults with HNC (oral, pharynx, paranasal sinus, larynx) using ICD-9 codes. We evaluated three periods of imaging and treatment patterns: 1) three months pre-diagnosis, 2) diagnosis-to-treatment initiation, and 3) post-treatment initiation. Patients receiving single-imaging modalities and multiple-imaging modalities were evaluated in relation to surgery, chemotherapy, radiation therapy, and combinations. Imaging and treatment intensity and variability by cancer types and geographic regions (Northeast, North Central, South, and West) were assessed using multinomial and multivariate logistic regression.  RESULTS: CONCLUSIONS: Commercially-insured HNC patients in the U.S. vary in imaging intensity and in the types of imaging modalities used, prior to and following initial diagnoses. Receiving multiple treatment interventions was associated with undergoing multiple imaging tests and more specifically, PET/CT.