Introduction Imaging experience made us suspect an overrepresentation of ponytails in riders admitted as polytrauma after falling from their horse. Methods In a single-centre case-control study conducted over three months, we reviewed the records of all admitted polytraumatised patients for trauma mechanism and presence of ponytail on CT. Cerebral CTs were reviewed in the three standard imaging planes using a bone or lung window. Ponytail was diagnosed if most or all of the hair on the head was gathered and secured at the back of the head with a hair tie. Data were analysed with Fisher's exact test. Results Seven female riders (mean age 22 years) were admitted after falling from their horse (study group); six of these riders wore a ponytail. No male riders were admitted. Therefore, only female polytraumatised patients having suffered any other trauma were selected as controls. The control group consisted of 13 patients (mean age 33,5 years), two of whom wore a ponytail. In three controls, all without ponytails, the trauma also had been related to a horse. Thus, horses were involved in 50% of the traumas included in this study. Ponytail was found more frequently in riders admitted after falling from their horse, p less-than 0,005. Conclusion Having an almost circumferential vision, horses may be scared by the sideways swaying of a ponytail worn by their own rider. In riders, ponytails can trigger a sensation of tightness or even headache which may impair focus. Thus, while female riders most likely wear ponytails for practicality, ponytails may increase the risk of accident by affecting rider and horse. Further studies are required to determine if the observed association between ponytails and trauma is causal. Funding none. Trial registration not applicable.