By the time of its establishment by the state legislature in 1850, it was known as "Sandy Hook" for the fishhook-shaped bend in the river at that point.

[6] It was chosen as the seat of the newly established Elliott County over nearby Newfoundland in 1869, owing to a generous donation of land for public buildings by resident James Hunter.

In 1872, the city was incorporated as "Martinsburg" in honor of Congressman John P. Martin.

The city resumed the name shortly after[6] and was reincorporated as "Sandy Hook" in 1888.

According to the United States Census Bureau, the city has a total area of 0.97 square miles (2.5 km2), all land.

Kentucky Route 32 leads east 39 miles (63 km) to Louisa and heads north out of Sandy Hook with KY 7, eventually leading northwest 27 miles (43 km) to Morehead.

[9] Sandy Hook is the hometown of late country music singer Keith Whitley.