Background: Roughly two-thirds of patients diagnosed with head and neck cancer (HNC) have advanced-stage disease and many are eligible for palliative care. However, only approximately 20% of patients actually receive palliative care after their HNC diagnosis. The factors that affect access to palliative care for these individuals are not well understood. This study investigates the sociodemographic and clinical variables associated with receipt of only palliative care among patients with HNC. Methods: Based on data from the National Cancer Database (NCDB), a retrospective cohort was built, consisting of adult individuals diagnosed with advanced-stage (stages III and IV) HNC between 2004 and 2018. Outcome of interest was receipt of only palliative care. Independent variables included race/ethnicity, sex, distance from the treatment facility, health insurance status, and comorbidity burden. To estimate the likelihood of receiving palliative care, we used a multivariable logistic regression model that took accounted the independent variables and adjusted for other demographic and clinical factors. Results: Among the 233,109 patients included in our cohort, 6,146 received only palliative care, forming our analytic cohort. In our final models, male patients had a lower odds of receiving palliative care only (adjusted odds ratio [aOR] = 0.91; 95% confidence interval [CI]: 0.84, 0.99). Non-Hispanic Black (NH Black) patients had a higher odds of receiving only palliative care, (aOR = 1.37; 95% CI: 1.22, 1.53), compared to Non-Hispanic White (NH White) patients. Patients who were uninsured (aOR = 2.22; 95% CI: 1.88, 2.61), on Medicaid (aOR = 2.66; 95% CI: 2.36, 3.00), or Medicare/other government insurance (aOR = 1.60; 95% CI: 1.44, 1.79) had a higher odds of receiving only palliative care compared to those with private insurance/managed care. Additionally, higher comorbidity burden was associated with higher the odds of receiving only palliative care only (aOR = 1.67; 95% CI: 1.37, 2.02). Conclusions: Among patients with HNC presenting with advanced-stage disease, receipt of only palliative care is mostly associated with being a Black patient, having a greater comorbidity burden, and inadequate health insurance status. It is critical to improve equitable access to care for patients with HNC in order to optimize survivorship and mitigate disparities in HNC.