The name of the river, originally called Sandy Creek by 1756, comes from the presence of extensive sand bars.

The tombstone of David White, an early settler along the river in Kentucky, marks his passing in 1817 with the note that he lived many years near the Mouth of the Big Sandy.

The accident was caused when a coal sludge impoundment owned by Massey Energy in Kentucky broke into an abandoned underground mine below.

Toxic pollutants including heavy metals such as mercury, lead, arsenic, copper and chromium were found in the sludge that spilled into these waterways.

Loretta Lynn's "Van Lear Rose" and Dwight Yoakam's "Bury Me" also mention the river.