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Introduction: Sport helmet effectiveness in preventing traumatic brain injury (TBI) has been repeatedly questioned. This study assesses the effect of helmet use on risk of TBI and other types of head injury (OTHI) in alpine sports., Methods: From 2012 to 2014, data on the injured population were collected by physicians in on-mountain clinics in 30 French ski resorts, and interviews were conducted on the slope to sample a noninjured control population. Two sets of cases (1425 participants with TBI and 1386 with OTHI) were compared with 2 sets of controls (2145 participants without injury and 40,288 with an injury to a body part other than the head). The effect of helmet use on the risk of TBI and OTHI was evaluated with a multivariate logistic regression adjusted for age, sex, sport, skill level, crash type, and crash location., Results: Using participants without injury as control, we found that helmet wearers were less likely to sustain any head injury (odds ratio [OR] TBI = 0.65; OR OTHI = 0.42). When considering participants with an injury to another body part as control, the risk of OTHI was lower among helmet wearers (OR OTHI : 0.61). However, no significant effect was found for the risk of TBI. Participants with low skill levels, those aged <26 and >50 years, snowboarders, and those involved in collision and in snowpark accidents were at higher risk of head injury., Conclusions: This study confirms the effectiveness of helmets in protecting users from head injuries but questions their effects on TBI, especially concussion., (Copyright © 2017 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.)