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Objectives: Head and neck cancer (HNC) incidence has been increasing worldwide. We investigated the familial aggregation of developing HNC if a first‐degree relative (FDR) is affected in a large database. Methods: This retrospective study utilized Taiwan National Health Insurance Database to assemble a cohort of all registered beneficiaries from 1997 to 2013 and identified diagnosed HNC patients with affected FDRs. Results: Of the 55,916 individuals diagnosed with HNC, 566 (1.01%) had affected FDRs. There were 525 (0.56%) males and 41 (0.05%) females. Age of onset of HNC was found to be earlier for those with an affected FDR at the fourth decade of life compared to the general population. The adjusted relative risks (RRs) of an individual with an affected FDR to develop HNC is 2.04 (95% confidence interval [CI], 1.85–2.26): 2.07 (95% CI, 1.88–2.29) if the affected relative was male, and 1.74 (95% CI, 1.31–2.30) if the affected relative was female. The greatest risk to develop HNC is if the affected individual is a twin with adjusted RR 33.04 (95% CI, 12.89–84.69). This is followed by an affected sibling at RR (95% CI) 3.46 (1.68–7.13), offspring at RR 2.28 (95% CI, 1.94–2.69), and parent at RR 1.66 (95% CI, 1.48–1.87). Conclusion: Familial tendency of HNC proves the probable contribution of genetic factors to develop cancer. In areca quid endemic region, there is a high likelihood that both environmental and genetic factors work in synergy to develop HNC. Level of Evidence: 3 Laryngoscope, 131:806–812, 2021 [ABSTRACT FROM AUTHOR]