The present-day highway largely follows the path of the Ōmagoe-kaidō, an Edo period road that linked the Kubota and Hirosaki feudal domains.

It heads west, passing through the cities of Goshogawara and Tsugaru, until it meets the Sea of Japan coastline in the town of Ajigasawa.

Also known as the Ōmagoe-kaidō,[2] there are several attractions along the winding coastal portion of the highway including Furofushi Onsen and the World Heritage Site, Shirakami-Sanchi around the border between Aomori and Akita prefectures.

[3] The registration of Shirakami-Sanchi as a World Heritage Site has resulted in an increase in the average daily traffic levels along the highway.

[6] National Route 101 was established by the Cabinet of Japan between the city of Aomori and Noshiro, Akita in 1953 along pre-existing roads including most of the Ōmagoe-kaidō.

[13] On 22 September 2018, a drunk driver that was traveling on the highway in the city of Tsugaru at a speed of 163 kilometers per hour (101 mph) caused an incident that involved four cars.