Objetive To analyze the burden of disease and changing trends of tension-type headache (TTH) in China and globally from 1990 to 2021. MethodsBased on the latest global burden of disease (GBD) 2021 data, the incidence, prevalence, disability-adjusted life years (DALYs), and age-standardised incidence rate (ASIR), age-standardised prevalence rate (ASPR) and age-standardised disability-adjusted life year rate (ASDR) of TTH as the indicators for disease burden assessment. And trends were analyzed by average annual percent change (AAPC). In-depth analysis was carried out by combining socio-demographic index (SDI), frontier analysis, and decomposition analysis methods. ResultsDuring the period from 1990 to 2021, the ASIR of TTH in China increased from 6 467.407 per 100 000 to 6 851.134 per 100 000 (AAPC=12.028%), the ASPR rose from17 174.483 per 100 000 to 18 525.067 per 100 000 (AAPC=42.680%), and the ASDR increased from 41.791 per 100 000 to 43.498 per 100 000 (AAPC=0.052%). In contrast, the global ASIR of TTH declined from 8 960.345 per 100 000 to 8 931.311 per 100 000 (AAPC=?1.004%), the ASPR decreased from 24 904.846 per 100 000 to 24 764.722 per 100 000 (AAPC=?4.905%), and the ASDR dropped from 56.989 per 100 000 to 55.694 per 100 000 (AAPC=?0.042%). Gender differences revealed that all disease burden indicators were consistently higher in females than those in males. However, in China, the rates of increase in these indicators were more significant among males. The crude incidence and prevalence rates exhibited a bimodal age distribution. ConclusionThe disease burden of TTH in China has demonstrated a significant upward trend, with notable disparities by gender and age.