Tension-type headache (TTH) is the most prevalent headache worldwide Stovner et al. (Cephalalgia 27:193-210, 2007aEuro cent aEuro cent); Robbins and Lipton (Semin Neurol 30:107-19, 2010aEuro cent aEuro cent); Jensen and Stovner (Lancet Neurol 7:354-361, 2008). Despite being the most prevalent primary headache type, there is still a relative lack of epidemiologic data when compared to that for migraine Robbins and Lipton (Semin Neurol 30:107-19, 2010aEuro cent aEuro cent). Out of the available data, it is apparent that there are wide variations and differences in tension-type headache epidemiology across different cultures Stovner et al. (Cephalalgia 27:193-210, 2007aEuro cent aEuro cent). This review will focus on reviewing and comparing the epidemiology of episodic and chronic TTH in adult populations across varying continental regions. This will include prevalence, cultural variations and differences in study methodologies, common precipitants and prognosis. Possible explanations for such widely varying prevalence rates among different cultures and regions will also be discussed.