Introduction: Radiation therapy in head and neck cancers has previously been associated with cerebrovascular complications such as aneurysm formation, atherosclerosis, and ischemic stroke. Radiation is also associated with extradural cranial hemorrhagic complications due to weakening of vessel walls and labile hypertension from baroreflex failure. We hypothesized radiation therapy in head and neck cancers would also be associated with intracranial hemorrhage. Methods: We performed a retrospective cohort study using inpatient and outpatient claims between 2008-2018 from a nationally representative 5% sample of Medicare beneficiaries. We included patients ≥65 years old with cancer of the oral cavity, nasal cavity, pharynx, or larynx, defined by ICD-9-CM and ICD-10-CM diagnosis codes, who underwent either radiation therapy or surgical tumor excision, defined by CPT codes. Intracranial hemorrhage was defined using ICD-9-CM and ICD-10-CM diagnosis codes for subarachnoid hemorrhage, intracerebral hemorrhage, and subdural hemorrhage. Cox proportional hazards regression was used to determine the association between radiation therapy and intracranial hemorrhage after adjustment for age, race, atrial fibrillation, coronary artery disease, hypertension, diabetes mellitus, congestive heart failure, chronic kidney disease, tobacco use, and alcohol use. Results: Of 15,990 eligible patients, 5,316 (33%) underwent radiation therapy. A total of 568 (3.5%) patients had an intracranial hemorrhage. In unadjusted analysis, radiation therapy was associated with an increased risk of intracranial hemorrhage (HR, 1.72, 95% CI, 1.40-2.10). This association was present after adjustment for age, race, and vascular risk factors (HR, 1.29; 95% CI, 1.04-1.59). Conclusions: In a nationally representative cohort of Medicare beneficiaries, radiation therapy for head and neck cancer was associated with an increased risk of intracranial hemorrhage.