The area was historically known as the Michinoku region or province. a term first recorded in Hitachi-no-kuni Fudoki (常陸国風土記) (654). There is some variation in modern usage of the term "Michinoku".

Tōhoku's initial historical settlement occurred between the seventh and ninth centuries, well after Japanese civilization and culture had become firmly established in central and southwestern Japan. The last stronghold of the indigenous Emishi on Honshu and the site of many battles. The region had maintained a degree of autonomy from Kyoto at various times throughout history.

The haiku poet Matsuo Bashō wrote Oku no Hosomichi (The Narrow Road to the Deep North) during his travels through Tōhoku.

The region is traditionally known as a less developed area of Japan.

The catastrophic earthquake and tsunami on March 11, 2011 inflicted massive damage along the east coast of this region, along with radioactive fallout.

Tōhoku, like most of Japan, is hilly or mountainous, with the Ōu Mountains running north-south. The inland location of many of the region's lowlands has led to a concentration of much of the population there. Coupled with coastlines that do not favor seaport development, this settlement pattern resulted in a much greater than usual dependence on land and rail transporation. Low points in the central mountain range fortunately make communications between lowlands on either side of the range moderately easy.

Tōhoku was traditionally considered the granary of Japan because it supplied Sendai and the Tokyo-Yokohama market with rice and other farming commodities. Tōhoku provided 20 percent of the nation's rice crop. The climate, however, is harsher than in other parts of Honshū and permits only one crop a year on paddy fields.

In the 1960s, iron, steel, cement, chemical, pulp, and petroleum refining industries began developing.