This retrospective study compared image quality between 60 head and neck CT angiography examinations performed with photon-counting CT (PCCT) and 53 performed with conventional energy-integrating detector CT (EID-CT), and assessed different PCCT reconstruction strategies. PCCT was associated with lower radiation exposure than EID-CT while maintaining high overall image quality. Thinner slices and sharper reconstruction kernels improved vessel sharpness and reduced blooming artifacts from calcified plaques and stents, but increased image noise and reduced signal-to-noise and contrast-to-noise ratios. A 1.0-mm Bv40 reconstruction provided a favorable balance for routine vascular assessment, whereas 0.4-mm Bv44 offered a balanced thin-section option and 0.2-mm ultra-high-resolution reconstructions provided additional value for lesion-focused evaluation of calcified plaques and stented vessels. Overall, the findings support tailoring PCCT reconstruction strategies to the specific clinical task to balance spatial resolution and image noise.