The invention provides an under-pressure drilling device for an oil-gas well mouth. The device comprises an elevator, a pressure balance pipe, a pressure balance valve, a drilling unit, a packing component, an adapter, a blowout prevention nozzle, a blowout prevention valve, a gate valve, a drill rod string, a pressure balance manifold, and a control console; the elevator is arranged at the end ofthe pressure balance pipe; the middle of the pressure balance pipe is of a hollow structure; the pressure balance valve is arranged at the other end of the pressure balance pipe; the drilling unit comprises a power mechanism and an executing mechanism which are connected with each other; the executing mechanism is arranged at one end of the pressure balance valve; in the drilling direction, the packing component, the adapter, the blowout prevention nozzle, the blowout prevention valve and the gate valve are connected in sequence; the drill rod string is arranged in the drilling device; one end of the pressure balance manifold is communicated with the hollow structure of the pressure balance pipe, and the other end is communicated with the adapter or the blowout prevention nozzle; and thecontrol console is used for starting tripping of the drill rod string and controlling the drilling speed of the drill rod string. The under-pressure drilling device for the oil-gas well mouth is convenient to operate and good in sealing performance.