The episode title is a reference to the short story "The Tell-Tale Heart" by Edgar Allan Poe. In addition, Bart actually hears the head talking when he is overcome with guilt, similar to Poe's character's hearing the still-beating heart of the man he murdered in the story.
When Bart awakes to a find the head of Jebediah Springfield in bed next to him, it is reminiscent of the scene from "The Godfather" where Tom Hagen (played by Robert Duvall) "persuades" studio chairman Jack Woltz to cast Fontane in the movie by leaving the severed head of the producer's prize racehorse in his bed.
When Bart skateboards in the streets, he shouts "Cowabunga!", the battle cry of the Teenage Mutant Ninja Turtles.
Originally, this episode was not a flashback, and it was made this way during the final stages of production.
This episode is referenced in the South Park episode titled "The Simpsons Already Did It".
When Bart meets Jimbo (with Kearney), he apparently knows of him already and tells us that he's, "the worst kid in school".
Marge pulls a Radioactive Man comic book from inside Bart's jacket before leaving the house for church.
This is the first time Smithers is shown with light gray hair and a green jacket.
This is the first time Chief Wiggum is shown with brown skin and black hair, although he made his debut appearance in "Homer's Odyssey" with his blue hair and yellow skin.
According to the producers, this episode marked the first hint towards Smithers' sexuality (When Mr. Burns mentioned that he loved Smithers, Smithers replies that "the feeling is more than mutual, sir.")
When Barney asks how long Bart's story will take Bart says, "23 minutes and 5 seconds," meaning the length of the episode.
In this episode, Dolph and Jimbo originally had each other's voice before they were later switched.
When the bullies and Bart were watching the clouds, Kearney noted a man being cut in the back by a switchblade; that man resembled Hans Moleman.
Several reruns of this episode, as well as the American DVD release of The Complete First Season cut out part of Bart's speech to the mob, in which he points out that removing the head made everyone realize that they were "taking the town's heritage for granted". This specific part of the speech did not exist in the original reel of the episode that was delivered to the Fox Network, and was the editorial creation of the network censors in compliance of the FCC's 1989 ruling that every serial animated television show transmitted include at least 28 seconds of educational content. However, this version of the ending is preserved on international editions of the DVD, such as Spain and Germany.
It is not explained how the citizens of Springfield came across the knowledge needed to arrange themselves into a mob to confront Homer and Bart with the head (although it is possible that Homer contacted the authorities beforehand).
Starting in Season 20, Jebidiah's head is sawed off in the intro by Jimbo and Kearney, despite them saying in this episode that they would never cut the head off.
This is the first episode to feature Tress MacNeille in the voice cast, voicing Dolph and Ms. Albright. She would later go on to appear in every episode, more than any of the "Also Starring" cast members, starting with Season 11.
The questions which Ms. Albright is asked, such as "do cavemen go to Heaven?" are all taken verbatim from a 1985 Life in Hell comic strip entitled "Kids' Questions About Death."