"Dead Head Fred" is a third-person action-adventure game that incorporates a variety of gameplay styles, including combat, platforming, and puzzles. The core gameplay of "Dead Head Fred" revolves around Fred's missing head and his ability to "switch" heads by defeating certain enemies, decapitating them, and collecting their heads (referred to as "headhunting"). As Fred explores the city of Hope Falls, he can collect an assortment of heads, each of which has unique abilities. Examples include the Stone Idol head, which Fred can use as a battering ram, and the Corpse head, which can be used to suck up and spit out water, gasoline, and other materials. Fred uses these heads to navigate the city of Hope Falls, and certain parts of the city are not accessible until certain heads are found. The high level of radiation in Hope Falls has led to a proliferation of grossly mutated worms, which the player can collect and use to upgrade Fred's heads and temporarily increase his fighting abilities, among other benefits. Also collectible are money and special items, which can be earned by defeating enemies or completing various side-missions. There are several minigames unrelated to the plot, such as pinball and fishing, scattered around the city.