Imprisoned for involuntary manslaughter during a carjacking, Travis Clyde Tuckton is released from prison in 2003, and shacks up with his disabled grandfather, Jake Martin, in the old shoemaker's secluded West Virginia home.

Jake elects to teach Travis everything he knows, starting with the family tradition of "headers"; the act of having sex with a hole drilled into a person's skull.

A parallel story concerns ATF agent Stewart Cummings, who has resorted to trafficking drugs in order to pay for his girlfriend Kathy's medicine.

Stewart returns home, and discovers Kathy doing cocaine and having sex with her doctor, having been faking her illness to get drug money this entire time.

[1] A half-star was given by DVD Talk, which concluded "Header is as stomach-churning as they come, but it's only on the surface: there's nothing genuinely unsettling about the film other than the massive number of problems hampering the final product".