BACKGROUND: Psychosocial factors exert a significant influence on primary headaches. However, little has been known about the agreement concerning the extent and nature of psychological processes on migraine and tension-type headache (TTH). METHODS: Fifty-five patients with primary headache were enrolled to participate in the study and 33 headache-free control subjects. A depression scale (BDI), an anxiety scale (STAI), a psychopathology scale (SCL-90-R), a stress coping scale (MCS), and a quality-of-life scale (WHOQOL-BREF) were administered to all the participants. RESULTS: The headache sufferers turned out to have various emotional problems, used more inefficient stress coping strategies and lead poor quality of life compared with those who had no headache. No distinctive psychological symptom was found between the two diagnosis groups, but the migraine group showed higher obsessive-compulsive symptoms than the TTH group, and the latter group showed higher levels of trait anxiety than the former. CONCLUSIONS: This study shows that the primary headache sufferers have various psychosocial problems. Accordingly, individual treatment approach focusing on the psychological symptoms is needed for the efficient management of headache.