The invention relates to the field of punching equipment, in particular to a head-adjustable numerical control punching machine tool. The head-adjustable numerical control punching machine tool comprises a punching die and a press machine for driving the punching die to conduct press joint, the punching die comprises an upper die body and a lower die body, and the upper die body comprises an upperdie seat, a material pressing plate and a punching head. A replacing assembly for replacing the punching head is arranged between the upper die seat and the material pressing plate and comprises a sliding rail for allowing the punching head to slide to the position under the center of the upper die seat and a positioning assembly for limiting the position of the punching head. The two ends of thesliding rail are each provided with pass holes for enabling the punching head to be mounted on the sliding rail, and the positioning assembly comprises a guiding rod vertically arranged by the side of the punching die, a first connecting rod mounted on the guiding rod in a sleeving mode, a second connecting rod hinged to the end, away from the guiding rod, of the first connecting rod, and a thirdconnecting rod hinged to the end, away from the first connecting rod, of the second connecting rod. According to the head-adjustable numerical control punching machine tool, the whole punching head replacement process is convenient and rapid and is more convenient than an existing punching head replacement mode, and the work efficiency is improved.