Voodoo Blood Bath

I agree that the shrunken heads are hard to read, I didn't see them at first! The cigarette/filter doesn't read too well. Almost looks like a paint brush. Perhaps if the filter was thinner and the cigarette longer?

My eye also wants the main portion of the image to be tilted counterclockwise, so the composition is more centered (but that might be more based on personal taste.)

The leaves in the background are pretty awesome, and the negative space with the white is nice, but perhaps the piece could use more of that to "pop" certain elements like the skulls and maybe more of the leaves.