04.5 Head issue

[DDalley]

I have an 04.5 Cummins 410k mi. bought new in 04. Either head gasket or possibly cracked head. Wife drove it thermostat stuck pegged in the red. She said only for a minute haha whatever. Puking out overflow under load so yes a head issue. My question is would it be wise to replace the head if it's cracked. Never been tuned oil changed every 5k miles

 

[crash68]

Given the mileage you have on the engine, it's probably either get the head checked and reuse it or if it's cracked and need a new one you'll want to weigh your options on a complete overhaul of the engine.
Cummins engines will rack up a ton of miles but if I remember correctly the '04.5 era engines have a B10 rating of 250K miles and has a B50 rating of 400K miles
If the truck body is in good shape might be worth dropping the extra $$ to refresh the whole engine and hopefully you'll get another +400K miles out of the truck