The Holy Roman Emperor received the imperial regalia from the hands of the Pope, symbolizing both the pope's right to crown Christian sovereigns and also the emperor's role as protector of the Catholic Church. The Holy Roman Empresses were crowned as well.

The Holy Roman Empire was established in 962 under Otto the Great. Later emperors were crowned by the pope or other Catholic bishops. In 1530 Charles V became the last Holy Roman emperor to be crowned by a pope, Clement VII, albeit in Bologna (Frederick III was the last to be crowned in Rome). Thereafter, until the abolition of the empire in 1806, no further crownings by the pope were held. Later rulers simply proclaimed themselves Imperator Electus Romanorum ("Elected Emperor of the Romans") after their coronation as German king.

Before being crowned emperor by the pope, a monarch first had to win the support of the majority of the seven prince-electors in the Imperial election, then to be crowned King of the Romans by an archbishop, for example that of Cologne, Mainz, or Trier. He then had to conduct an Italienzug (Romzug), leading his army from Germany to Rome and occasionally having to fight off enemies barring the way, making his coronation into a military expedition. Some elected or crowned Kings of the Romans never made it that far, and thus were never confirmed as Holy Roman Emperors by the Holy See. The papal coronation was necessary for the Imperial title until 1508, when the Venetians blocked the journey of Maximilian I, and he was instead proclaimed emperor elect by Pope Julius II at Trent. This established the right of elected German monarchs to use the imperial title.

Successors of Charlemagne were crowned in Rome for several centuries, where they received the imperial crown in St. Peter's Basilica from the pope.

The Iron Crown of Lombardy (with the title King of Italy or King of the Lombards) was conferred in the Church of St. Ambrose at Milan or at the cathedral of Monza, that of Burgundy at Arles. The German crown—which came to be the most important of all—was usually given at Aachen. From 1562 until the last German coronation in 1792, the emperors-elect were crowned kings of Germany in Frankfurt Cathedral, which had already in 1356 had become the established site for the imperial elections.

The German coronation ceremony first required the electors to meet at Frankfurt, under the presidency of the elector-archbishop of Mainz, who formally summoned the electors and had the right of the last vote. The new emperor-elect was led to the high altar of the cathedral and seated, then conducted to a gallery over the entrance to the choir, where he sat with the electors while his election was proclaimed. The coronation itself took place on a subsequent day.

If the coronation was performed (as usual before 1562) at the Palatine Chapel at Aachen (now Aachen Cathedral), then the archbishop of Cologne, as local metropolitan, was the chief officiant and was assisted by the two other clerical electors, the archbishop of Mainz and the archbishop of Trier. These three archbishop-electors met the emperor-elect at the entrance of the church, where the archbishop of Cologne said the prayer, "Almighty, everlasting God, your servant,..." The choir sang the antiphon, "Behold, I send my Angel..." (Ecce mitto Angelum meum...) as the emperor-elect and the archbishops filed into the church. The archbishop of Cologne then said the prayers, "God, who knows the human race,..." and "Almighty and everlasting God of heaven and earth,...." The Mass then began with the propers of the Feast of the Epiphany and the collect for the Feast of St. Michael. After the sequence and the Litany of the Saints, the archbishop of Cologne put six questions to the emperor-elect, each time receiving the response "I will": 1. Will he defend the holy faith? 2. Will he defend the holy church? 3. Will he defend the kingdom? 4. Will he maintain the laws of the empire? 5. Will he maintain justice? 6. Will he show due submission to the pope? The emperor-elect then laid two fingers on the altar and swore his oath. The Recognition then followed, with the emperor-elect asking those assembled to accepted him as their king, three times receiving the response "Let it be done".

The archbishop of Cologne then said the prayers, "Bless, Lord, this king,..." and "Ineffable God,...." The archbishop then anointed the emperor-elect with the oil of the catechumens on his head, breast and shoulders, saying, "I anoint you king with the oil of sanctification in the name of the Father and of the Son and of the Holy Spirit. Amen." and then on the palms of both hands, saying, "Let these hands be anointed, as kings and prophets were anointed and as Samuel anointed David to be king may you be blessed and established king in this kingdom over this people, whom the Lord, your God, has given you to rule and govern, which he vouchsafes to grant, who with the Father and the Holy Spirit, lives and reigns,...." He was then vested in the imperial robes, including buskins, a long alb, a dalmatic, a stole crossed priest-wise over the breast, gloves, and mantle. The sword was given with the words, "Receive this sword at the hands of us bishops...." The ring was given with the words, "Receive this ring of royal dignity...." The sceptre and orb were given with the words, "Receive this rod of virtue and equity...." Finally the crown was set on his head conjointly by the three archbishop-electors with the words, "Receive this royal crown...." The oath was taken again, this time in the direct form in both Latin and German, "I promise and pledge in the sight of God...." The responsory is chanted, "My soul is longing,..," and the king is enthroned with the words, "Stand fast and hold firmly...." At the coronation of Charles V the archbishop-elector of Mainz preached a homily at this point.