Paintball is an "extreme sport" that has been steadily growing in popularity since the early 1980s. Although this activity is considered recreational, there are a number of inherent dangers associated. Most notably, the number of head and neck injuries due to paintball participation has been increasing in recent years. In this paper we present the first reported case of occipital artery traumatic pseudoaneurysm resulting from a paintball accident. The presentation, diagnosis and intraoperative findings are detailed. A discussion including a review of the literature is also presented. The authors recommend a re-evaluation of guidelines within the paintball sporting industry, including improvements in protective equipment.