On her comeback ballad “Head Above Water”, Avril Lavigne sings about fighting for her life. The song is a piano-driven pop-rock anthem, in which Lavigne tries to stop herself from drowning under the immense pressure from her battle with Lyme Disease, of which she had not been open about for a long time. She also prays to God and makes references to religion.

The song is her first single in 3 years since her 2015 song “Fly“ for the Special Olympics. During her break from making music, Lavigne had an extensive life or death battle with Lyme Disease. She opened up about her battle in an interview for ABC News in 2015 stating "it was literally the worst time of my life” and despite seeing the top specialists and doctors she could, they were misdiagnosing her with depression and chronic fatigue syndrome.

In a letter written to fans weeks before the single’s release, Lavigne stated that she wrote her most personal and deeply song from her bed, while fearfully coming to terms with the possibility of losing her life.

“Head Above Water” was released as the first single from her sixth studio album of the same name. A music video for the song was released on September 27, 2018.