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Developing countries are subject to increased motorization, particularly in the number of motorcycles. As helmet use is critical to the safety of motorcycle riders, the goal of this study was to identify observable patterns of helmet use, which allow a more accurate assessment of helmet use in developing countries. In a video based observation study, 124,784 motorcycle riders were observed at seven observation sites throughout Myanmar. Recorded videos were coded for helmet use, number of riders on the motorcycle, rider position, gender, and time of day. Generally, motorcycle helmet use in Myanmar was found to be low with only 51.5% percent of riders wearing a helmet. Helmet use was highest for drivers (68.1%) and decreased for every additional passenger. It was lowest for children standing on the floorboard of the motorcycle (11.3%). During the day, helmet use followed a unimodal distribution, with the highest use observed during the late morning and lowest use observed in the early morning and late afternoon. Helmet use varied significantly between observation sites, ranging from 74.8% in Mandalay to 26.9% in Pakokku. In Mandalay, female riders had a higher helmet use than male riders, and helmet use decreased drastically on a national holiday in the city. Helmet use of motorcycle riders in Myanmar follows distinct patterns. Knowledge of these patterns can be used to design more precise helmet use evaluations and guide traffic law policy and police enforcement measures. Video based observation proved to be an efficient tool to collect helmet use data., (Copyright © 2019 Elsevier Ltd. All rights reserved.)