Tension-type headache (TTH) is a common primary headache disorder, and recent research has focused on various treatment options. However, studies evaluating acupuncture for TTH from the perspective of Traditional Chinese Medicine (TCM) and its mechanisms are limited. This literature review synthesizes findings from twelve clinical studies that investigated acupuncture for TTH treatment. Data analysis was conducted for acupoint selection, types of acupuncture, treatment duration and needle retention time in these studies considering TCM principles. Our results indicate that acupuncture practitioners should select acupoints based on TCM syndrome differentiation and patient-specific factors. The optimal treatment duration is at least four weeks, with each session lasting a minimum of 20 minutes, and 30 minutes per session is recommended for enhanced efficacy. Additionally, the therapeutic effects of acupuncture on TTH may involve mechanisms such as the inhibition of myofascial trigger points and the modulation of central sensitization.