The Dutch guideline for patients suspected of head and neck paragangliomas (HNPGLs) recommends magnetic resonance imaging (MRI) and/or computed tomography (CT) of the head and neck area. Additionally, it suggests considering additional nuclear imaging. The aim of this study was to evaluate the outcomes of GaGa-DOTATOC PET/CT compared to MRI in patients with suspected HNPGLs and carriers of genetic variations. In this single-center pilot study, retrospective data were obtained from consecutive patients between 2016 and 2023. Both MRI and GaGa-DOTATOC PET/CT were performed within 12 months. The primary outcome was the location of HNPGLs. A total of 25 consecutive patients were included, and 7 patients (28.0%, = 0.5) showed differences between the imaging modalities, of whom 5 patients had unexpected localizations with additional uptake by somatostatin receptors (SSTR) on the GaGa-DOTATOC PET/CT. The authors recommend performing baseline imaging with GaGa-DOTATOC PET/CT (if available) in variant carriers and using MRI/CT for follow-up according to the regional protocol, thereby shifting the gold standard for baseline imaging from MRI/CT to GaGa-DOTATOC PET/CT.