The life time prevalence of episodic tension headache ranges between 13-66%, of chronic tension headache between 1-3%. In most studies a slight preponderance of women was found. Approximately 20% of persons afflicted by tension headache seek for medical help. The costs of tension headache are mainly indirect ones due to lost work days. Increased pain sensitivity of the pericranial muscles, psychosocial stress and psychiatric disorders are discussed as main pathophysiological mechanisms. Taking into consideration the uncertainty of the entity "tension headache" tricyclic antidepressants and psychotherapy (biofeedback, stress management therapy, autogenic training) are effective. The superiority of a multicomponent therapy with tricyclic antidepressants and stress management therapy over pharmaceutical and psychotherapeutic treatment or placebo alone was demonstrated in one study.