The episode opens with a flashback to Cooper Howard on a Western film set before the nuclear war. Cooper, playing a sheriff, objects to a violent scene where his character must kill a man, but the director insists this is what the audience wants. Cooper learns the writer has been fired for being a communist, setting a tone of ideological conflict and personal frustration in the pre-apocalyptic world.

In the present wasteland, Cooper Howard, now known as The Ghoul, is suffering from severe coughing fits and relies on an inhaler. He is on a mission to retrieve Dr. Wilzig’s severed head, which has been taken by Lucy. The Ghoul encounters Lucy carrying the head in a bag, and they have a tense confrontation. Lucy is determined to use the head as leverage in her quest to find her kidnapped father.

Meanwhile, Maximus, who has assumed the identity of Titus, deals with the consequences of his recent fight with The Ghoul. He receives a call from the Brotherhood of Steel, who believe he is Titus and expect him to deliver the power armor. Maximus is anxious about being discovered as an impostor and decides to get his armor repaired in the town of Filly.

As Maximus returns, he finds a group of criminals attempting to break into his power armor. A brutal fight ensues: Maximus defends himself with skill and ferocity, killing one of the attackers. After the fight, Thaddeus, the new squire, arrives. Maximus asserts his authority by ordering Thaddeus to clean his codpiece, establishing their new dynamic.

Back in Vault 33, the survivors are struggling to recover from a recent raid by Moldaver’s group. Norm, Lucy’s brother, leads a meeting to decide how to handle the captured raiders. Some suggest rehabilitating and integrating them into vault society by teaching them Shakespeare, morals, or calculus. Norm opposes this, arguing that the raiders should be killed. His harsh stance shocks the others, and he quickly apologizes.

During the meeting, it is revealed that the vault’s water chip is destroyed, leaving only enough water for two months, not counting the prisoners. The co-overseer system is failing, and tensions rise as the vault’s future becomes uncertain. Norm gains an ally who reminds him that his father would have done the right thing, hinting at deeper family and leadership conflicts.

Lucy continues her mission with Dr. Wilzig’s severed head, which contains a mysterious element injected behind the ear by the doctor before his suicide. This element makes the head a valuable bargaining chip sought by multiple parties, including the woman named Moldaver.

A flashback reveals that before the war, Cooper Howard was affiliated with Vault-Tec, the organization responsible for building the vaults as social experiments. This connection adds depth to his character and explains his complex identity as both a symbol of Vault-Tec and a desperate survivor known as The Ghoul.

The episode ends with The Ghoul chasing a human-like crustacean creature underwater, showing his pragmatic but desperate nature as he tries to maintain the drugs that keep him alive. Lucy remains determined to use the head to negotiate and find her father, while Maximus solidifies his position in the wasteland through violence and cunning. The vault dwellers face internal strife and dwindling resources, setting the stage for further conflict.

In episode 3, Lucy has an unpleasant encounter with the Ghoul after he finds Wilzig's headless corpse and follows her. She reaches the underwater remains of Hollywood Boulevard where a mutated Axolotl called a gulper swallows Wilzig's head. As Lucy escapes the gulper, she is held at gunpoint by the Ghoul.

In this episode, Maximus assumes Titus' identity, though specific scenes detail his actions and interactions while doing so, including moments with his new squire, which contribute to character development and plot progression.

Wilzig's head is swallowed by a mutated Axolotl known as a gulper in the underwater ruins of Hollywood Boulevard, which becomes a key plot point as Lucy tries to escape and the Ghoul pursues her after finding Wilzig's headless corpse.

Vault 33 faces internal conflict with raiders inside the vault. Norm advocates killing the raiders, while others suggest rehabilitating and integrating them into society. The water chip is destroyed, leaving only two months of water supply, increasing the stakes and tensions among the vault residents.

The episode flashes back to the 'before times,' showing Cooper Howard filming a movie scene and arguing with a director. This flashback contrasts the pre-apocalyptic world with the present, highlighting themes of identity and individualism, and revealing Cooper Howard's role as the face of Vault-Tec iconography.

The TV show Fallout, Season 1, Episode 3 ("The Head") is not family friendly and is generally rated for mature audiences (16+ or similar) due to its content.

Potentially objectionable or upsetting aspects for children or sensitive viewers in this episode include:

• Graphic violence and gore, including bloody fights, injuries, and dismemberment, sometimes shown in detail or implied off-screen but still disturbing.
• Strong and frequent profanity, with about 22 obscenities in this episode, including many uses of the "f" word.
• Psychological intensity, focusing on mental fragility, paranoia, and fear, which may be unsettling.
• Sexual content, including limited sex scenes and sexual references, though not highly graphic.
• Disturbing imagery, such as mutilated bodies, mutated creatures, and scenes involving cannibalism or flesh-eating.
• Themes of suicide and drug use are present in the series overall.
• Some brief references to bestiality in a humorous context.

These elements combine to create a dark, intense, and mature atmosphere that is not suitable for children or viewers sensitive to violence, strong language, or disturbing themes.