The origins of Fivizzano are unknown. The first settlings were probably Roman but the first documents about the town date from the Middle Ages, when the village was an important trading center. At that time, the village relied on the nearby Castello (castle) della Verrucola for its safety, and it was at the center of the fights between the families trying to control the Val di Magra.

For a long period, the territory of Fivizzano was under the rule of Spinetta Malaspina il Grande; this latter, however, had to give up in 1316 to Castruccio Castracani, who literally put Fivizzano to fire and sword. After a few years the town returned to Spinetta but in 1404 it was conquered by Firenze.

Firenze dominion ensured a new stable environment that was beneficial to trade and to Fivizzano's economy in general; as a consequence, the town enlarged and changed in aspect. Following the attacks by Charles VIII in 1494 and those by the Spaniards in 1537, new walls were built to protect the prosperous town. In the XVIII century, by will of the Emperor Francesco I, Fivizzano went under the rule of Pontremoli. After a short dominion by the French during the Napoleonic period, the whole area was annexed to the Granducato of Toscana ("grand duchy of Tuscany"), which controlled Fivizzano until the Unità d'Italia (reunification of Italy under the Regno d'Italia).