This structured narrative review synthesizes evidence from 32 studies to propose a multidimensional framework for tension-type headache, emphasizing that clinical variability and chronicity arise from dynamic interactions among musculoskeletal factors, central sensitization, psychosocial influences, and lifestyle behaviors. The model conceptualizes tension-type headache along a continuum from peripheral nociceptive mechanisms in episodic disease to central pain modulation dysfunction in chronic forms, and suggests that patients may be stratified by dominant mechanistic profiles to guide personalized assessment and management. However, the evidence base is largely observational and heterogeneous, and the framework is hypothesis-generating rather than validated for clinical use.