The album draws inspiration from Lavigne's battle with Lyme disease, with her describing the album as an "emotional journey". The title track was released as the lead single from the album in September 2018, followed by "Tell Me It's Over" as the second single in December 2018, "Dumb Blonde" as the third single the week of the album's release, a collaboration with rapper Nicki Minaj and "I Fell in Love with the Devil" as the fourth single in June 2019.
Head Above Water received generally mixed reviews from music critics. While some praised Lavigne's vocal performance, themes and maturity compared to the singer's previous works, some noted the "generic" sound of the album, criticizing the lyrics and production of certain songs. The album debuted at number five on the Billboard Canadian Albums chart, making it Lavigne's sixth album to enter the top ten in Canada. In the United States the album debuted at number thirteen on the Billboard 200 chart. On its second week the album fell to number 113. On the Billboard Independent Albums, the album peaked at number one, the album peaked at number five on the US Top Album Sales Billboard and stayed on the chart for six weeks. In the United Kingdom the album debuted and peaked at number ten on the UK Albums OCC chart with sales of 5,766 equivalent units. It also went straight to number one on the UK Independent Albums.
In support of the album, Lavigne embarked on the Head Above Water Tour, starting on September 14, 2019 (her first tour in nearly five years following the Avril Lavigne Tour).
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