Head and neck paragangliomas can be a clinical challenge to providers who identify these rare neural crest-derived tumors. They present with unique clinical exam findings, radiologic characteristics, and histopathologic features. Providers should approach management, including surgery, radiation, and observation, with up-to-date knowledge on the literature, particularly as a pertains to hereditary paraganglioma syndrome. Recent studies have changed the way patients should be managed. There is a greater emphasis on watchful waiting but also new data on when, where and how patients be serially imaged to monitor for recurrence, progression, or second primary paragangliomas. The first 30 minutes of this panel will be committed to reviewing: 1) initial workup of newly diagnosed paragangliomas, 2) pros and cons of each treatment option, 3) surgical considerations such as when to embolize, 4) how patients should be actively surveilled long-term, and 5) how genetics can inform each of these considerations. This will be followed by 5- to 10-minute case presentations to apply these concepts to the management of actual patients. This will be conducted using audience poling software but discussion among the panelists will highlight key principles and discuss consensus opinions from the audience.