Usually means: Direct competition between two parties.
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We found 22 dictionaries that define the word head to head:

General (18 matching dictionaries)
  1. head-to-head: Merriam-Webster
  2. head-to-head, head to head: Oxford Learner's Dictionaries
  3. head-to-head: American Heritage Dictionary of the English Language
  4. head-to-head, head-to-head: Collins English Dictionary
  5. head-to-head: Vocabulary.com
  6. head-to-head: Cambridge Advanced Learner's Dictionary
  7. head-to-head, head to head: Wiktionary
  8. head-to-head: Webster's New World College Dictionary, 4th Ed.
  9. head-to-head: Infoplease Dictionary
  10. head-to-head, head to head: Dictionary.com
  11. head-to-head: Cambridge Essential American English Dictionary
  12. head-to-head: Rhymezone
  13. head-to-head: FreeDictionary.org
  14. head-to-head: Mnemonic Dictionary
  15. head-to-head: TheFreeDictionary.com
  16. head to head: Longman Dictionary of Contemporary English

Miscellaneous (1 matching dictionary)
  1. AbbreviationZ (No longer online)

Slang (1 matching dictionary)
  1. Head to Head: Urban Dictionary

Sports (1 matching dictionary)
  1. Head-to-Head: Backgammon

Tech (1 matching dictionary)
  1. Glossary of Landscape Irrigation Terms (No longer online)

Definitions from Wiktionary (head to head)

adverb:  In a very close one-on-one situation.
adverb:  (figurative, of skill, product features, etc.) In the same level as someone else.
adverb:  Against, in direct opposition.

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