In earlier times, only members of the Imperial Family could be appointed sesshō. The Kojiki reported that Emperor Ōjin was assisted by his mother, Empress Jingū, but it is doubtful if it is a historical fact. The first historical sesshō was Prince Shōtoku who assisted Empress Suiko.
The Fujiwara clan was the primary holder of the kampaku and sesshō titles. More precisely, those titles were held by the Fujiwara Hokke (northern Fujiwara family) and its descendants, to which Fujiwara no Yoshifusa belonged.
In 866, Fujiwara no Yoshifusa became sesshō. He was the first not to belong to the Imperial house. In 876, Fujiwara no Mototsune, the nephew and adopted son of Yoshifusa, was appointed to the newly created office of kampaku.
After Fujiwara no Michinaga and Fujiwara no Yorimichi, their descendants held those two offices exclusively. In the 12th century, there were five families among the descendants of Yorimichi called Sekke: Konoe family, Kujō family, Ichijō family, Takatsukasa family and Nijō family. Both the Konoe and Kujō family were descendants of Yorimichi, through Fujiwara no Tadamichi. The other three families were derived from either the Konoe or Kujō families. Until the Meiji Restoration of 1868, those five families held those title exclusively with the two exceptions of Toyotomi Hideyoshi and his nephew Toyotomi Hidetsugu.
The offices and titles of sesshō and kampaku were abolished by the declaration of the Imperial Restoration in 1868 during the Meiji Restoration in order to reorganize the government structure. The office and title of sesshō was stipulated under the former Imperial Household Law in 1889 and also under the new Imperial Household Law in 1948. Under these laws, the officeholder of sesshō is restricted to a member of the Imperial family. Crown Prince Hirohito, before becoming Emperor Shōwa, was sesshō from 1921 to 1926 for the mentally disabled Emperor Taishō. He was called sesshō-no-miya (摂政宮, "the Prince-Regent").