This study investigated the role of stress in recurrent tension headache. Although recurrent tension headache sufferers (N=117) and matched headache-free controls (N=174) reported similar numbers and types of stressful life events, headache sufferers reported a greater number of chronic everyday stresses or daily hassles than did controls. Recurrent tension headache sufferers also appraised the stressful events they experienced more negatively than did controls, and employed less effective coping strategies in their efforts to manage stressful events. When the potential impact of a stressful event was ambiguous, recurrent headache sufferers appraised this event more negatively and themselves as having less control over the event than did headache-free controls. In their coping efforts, recurrent tension headache sufferers also placed greater reliance on the relatively ineffective coping strategies of avoidance and self-blame, and made less use of social support than did controls. These findings suggest that research on the role of stress in tensionheadaches should focus not on the occurrence of major stressful life events, but on the recurrent headache sufferer's cognitive appraisals of stressful events and efforts to cope with stress.