We present a system for head motion tracking in 3D brain imaging. The system is based on facial surface reconstruction and tracking using a structured light (SL) scanning principle. The system is designed to fit into narrow 3D medical scanner geometries limiting the field of view. It is tested in a clinical setting on the high resolution research tomograph (HRRT), Siemens PET scanner with a head phantom and volunteers. The SL system is compared to a commercial optical tracking system, the Polaris Vicra system, from NDI based on translatory and rotary ground truth motions of the head phantom. The accuracy of the systems was similar, with root mean square (rms) errors of 0.09 degrees for ±20 degrees axial rotations, and rms errors of 0.24 mm for ± 25 mm translations. Tests were made using (1) a light emitting diode (LED) based miniaturized video projector, the Pico projector from Texas Instruments, and (2) a customized version of this projector replacing a visible light LED with a 850 nm near infrared LED. The latter system does not provide additional discomfort by visible light projection into the patient's eyes. The main advantage over existing head motion tracking devices, including the Polaris Vicra system, is that it is not necessary to place markers on the patient. This provides a simpler workflow and eliminates uncertainties related to marker attachment and stability. We show proof of concept of a marker less tracking system especially designed for clinical use with promising results.