BACKGROUND: Understanding the changing burden of head and neck cancers (HNC) is essential to guide public health interventions and inform cancer care strategies. METHODS: We conducted a cohort study using routinely collected primary care data Clinical Practice Research Datalink (CPRD) GOLD from the United Kingdom. Adults aged ≥ 18 years with ≥ 1 year of prior history were included. We estimated crude and age-standardised incidence rates (IRs) and one-, five-, and ten-year survival from 2000 to 2021, stratified by age and calendar year. Findings from CPRD GOLD were compared with primary care data from CPRD Aurum (England only). RESULTS: There were 12,455 patients with a diagnosis of HNC from CPRD GOLD (69.2 % male; median age 64 years). Crude incidence in GOLD increased from 9.08 (95 % CI: 7.88-10.42) per 100,000 person-years in 2000-15.59 (14.07-17.23) in 2021, with similar trends observed in CPRD Aurum. Age-standardised incidence trends were attenuated overall but remained elevated for oropharyngeal and tongue cancers. Five-year survival improved modestly, from 53.8 % (95 % CI: 51.4-56.3 %) in 2000-2004-58.7 % (56.5-60.9 %) in 2015-2019. CONCLUSIONS: Incidence increases for HNC were attenuated after age standardisation, suggesting a contribution of demographic ageing, although elevations persisted for specific subsites. Small improvements in long term survival highlights more research is needed to improve earlier diagnosis which will lead to better patient outcomes.