Objective: Selection of the right treatment strategy for head and neck paragangliomas is important because of their tendency to bleed and their close association with the vital organs. The aim of this study was to determine the optimal treatment approach considering the clinical features (e.g. localization, size, bilateralism, close association with vital organs) as well as the age and general condition of the patients. Material and Methods: We retrorespectively examined the records of patients who were treated for head and neck paragangliomas for the presence of tumors and systemic diseases that may have affected the treatment process between 1995 and 2011. The treatment approaches chosen were evaluated by considering tumor properties and the general condition of the patients. Results: Fourteen patients aged 30 to 86 years were included in the study. Eight patients underwent total surgical excision (57.14%) with cervical tumor diameter less than 7 cm and no invasion of vital organs like carotis and cranial nerves, as well as a patient (7.14%) with cervical tumor diameter 10 cm and with invasion of the arteria carotis interna. One patient (7,14%) with bilateral carotid tumor body, a poor general condition and high risk for surgery received radiotherapy. Another patient (7.14%) who refused to receive the therapy was periodically monitored by radiological imaging. Three patients (%21.42) with jugulotympanic paragangliomas were treated with lateral skull base approaches. Conclusion: There is no standard treatment approach for the head and neck paragangliomas. The treatment approach has to be determined by examining the properties of the tumors and the general conditions of the patients. Preparative imaging techniques may provide important clues to surgeons for the optimal treatment approach.