The present study aimed to investigate elementary school principals’ self-reported causes of work-related stress, their coping strategies to deal with stress and the support they need for their leadership. Seventy-six principals filled in the questionnaire, which included open-ended questions. Qualitative content analysis was used to analyse the data. The results showed that the main sources of stress were workload, interpersonal conflicts, a lack of resources and internal pressures. Moreover, principals used emotion-focused, problem-focused and social coping to deal with stress. Additionally, principals reported a need for problem-focused support and social support for their leadership. The results revealed the importance of social support and coping for principals’ occupational wellbeing. A more intimate approach to principals’ perceptions about the causes of occupational stress, their coping strategies and the support they need provides opportunities to consider diverse personal requirements, which may be fundamental in promoting principals’ occupational wellbeing.