Green’s Dictionary of Slang

hole in one’s head n.

1. [1940s+] (US) a lack of common sense.

2. [1950s] nonsense, lies.

SE in slang uses

In phrases

need like a hole in the head (v.) (also need like a third nut) [joc. use of SE but note Yid. ich darf es vi a loch in kop, ‘I need that like a hole in the head’]

[1940s+] to not need at all.