Eastern and western spotted skunks (Spilogale putorius and Spilogale gracilis) serve as definitive hosts for skunk cranial worm (Skrjabingylus chitwoodorum), a metastrongylid nematode that spends its adult stage inhabiting the frontal sinuses of the host cranium. Skunk cranial worm can cause severe damage to the skull of spotted skunks, and this damage is identifiable in preserved specimens. We visited six mammal collections between 2016 and 2018 and used 578 spotted skunk skull specimens to identify patterns in prevalence and severity of skunk cranial worm damage in spotted skunks. Specimens were collected between 1895 and 1981 from across the US. We assessed effects of host genetic clade, collection year, precipitation, and sex on prevalence and severity rates. We hypothesized that the midwestern genetic clade (plains spotted skunk, Spilogale putorius interrupta), which experienced a range-wide population decline in the mid-1900s, would experience the highest infection and severity rates. We expected precipitation, but not sex to influence infection and severity. Our top models indicated that host genetic clade, precipitation in the year prior to specimen collection, and the year prior to specimen collection best predicted prevalence and severity of skunk cranial worm. We suggest the positive association with precipitation is a result of local availability of gastropods, the intermediate host for skunk cranial worm. There was a negative association between prior year and prevalence, but the severity of damage increased over time for all clades. Given concerns over population declines of spotted skunks as well as observations of increasing damage over the past century, there is a need for further research on the impacts of cranial worm infection on individual-scale behavior, reproduction and survival, and on population-scale demographics.