Please note: some of the links in this article point to gory or graphic horror movie scenes

There are two schools of thought when it comes to film music: some say you should scarcely notice it, while others are attuned to every flattened fifth. Being a musician as well as a film journalist, I've always been staunchly in the latter camp (although I did have to look up "flattened fifth"). It seems inconceivable to me that we should fail to notice something as profoundly affecting as a movie soundtrack, and that goes double for the horror genre.

From the moment Bernard Herrmann's violins assaulted the shower-loving public in Psycho, horror soundtracks have rarely been content as mere background gloop. James Bernard's music for the Hammer films for instance – a strident mix of horns, violins and clattering percussion – is gallopingly melodramatic, although one has to say it often raises more giggles than goosebumps (think of his brass section blaring "DRA-culaaaaa!!" whenever You-Know-Who is around). A more innovative approach came from Ennio Morricone, famed for his 1960s spaghetti western scores, who brought a shuddering, paranoiac quality to the early 70s horror-thrillers of Dario Argento (The Bird With the Crystal Plumage), Aldo Lado (Short Night of the Glass Dolls) and Lucio Fulci (A Lizard in a Woman's Skin), based on brittle modern jazz, weird electronic effects, and rampant atonal twanging.

Admittedly his best scores weren't always for the best films; Umberto Lenzi's daft-as-a-brush Spasmo, for instance, is blessed with a nerve-shredding Morricone score (standout track: Stress Infinito) far better than it really deserves.

If I had to choose just one great horror soundtrack from the 1970s, I'd go for The Texas Chain Saw Massacre. Relentless, disturbing and totally "out-there", this groundbreaking work arose out of free improvisations by the film's director Tobe Hooper and his musical associate Wayne Bell. Rather than composing melodic themes for the characters, or dutifully applying motifs to particular events, Hooper and Bell approached the soundtrack like vengeful deities, raining down storms of pure nightmare. The sound design rumbles with elemental violence; it's difficult to discern precisely which musical instruments, if any, are responsible. When I spoke to Bell a few years ago he told me that a signature ingredient was "an upright bass, which we did all sorts of torturous things to during the Chain Saw sessions". There's also lots of tape manipulation (slowed-down and speeded-up gongs), and what sounds like a heavily asthmatic pedal-steel guitar (it is set in Texas, after all). Hooper and Bell smear these cues (with ad hoc titles such as Seethe and Madness) throughout the film, creating a dense, expressionist impasto into which screams, chainsaw engine noise and murderous gibbering are embedded; the effect is to completely mire you in the film's claustrophobic horror. (A more recent equivalent would be the extraordinary electronic score for Gaspar Noé's Irreversible, by Daft Punk's Thomas Bangalter.)

A short-lived but rewarding trend for progressive rock in horror began when William Friedkin used Mike Oldfield's Tubular Bells in The Exorcist, proving that music designed for stoned headphone voyaging actually suited the genre perfectly. Italian prog-rockers Goblin contributed eccentric riffage to Dario Argento's brutal and beautiful Deep Red (standout track: Death Dies), but they really hit the motherlode on their second Argento collaboration, Suspiria (1977). If ever a film set out to disprove the argument that the best film music is that which you don't hear, this is it. Built around a melody that drags Tubular Bells into a cackling Mittel-European whirlwind, Suspiria is a demonic assault that only the stone deaf could fail to notice. Film critic Alexander Walker famously referred to Goblin's contribution as the sound of "500 cats having their tails trampled on in unison". The key word there is "unison" – make no mistake, there's method in Goblin's cacophony, if not always in their film choices. Like Morricone, they occasionally gave brilliant work to dumb movies; listen out in particular for their sublime score to Luigi Cozzi's goofy Alien rip-off, Contamination (1980).

With the advent of affordable synthesisers came the rise of the cheap synth score. In 1978, John Carpenter was putting the finishing touches to his third low-budget feature, Halloween. Being fond of synthesisers, and knowing his way around a piano, he elected to save money by writing and performing the score himself; a decision that helped turn his simple, elegantly shot slasher film into one of the biggest independent hits of the 1970s. For the devastatingly effective main theme, Carpenter employs an insistent metronomic pulse, but with a twist; the piano taps out five beats to the bar (shades of prog rock again). Meanwhile, the synthesiser provides a rapid "ticker-ticker-ticker-ticker" in the background. This, combined with the oblique 5/4 time signature, instils a jittery sense of something moving at the periphery of your attention, perfectly in keeping with Carpenter's canny use of widescreen framing to create menace.

Horror went mainstream in the 1980s, but not before the smartest of the 70s freaks, David Cronenberg, delivered his sci-fi/horror masterpiece Videodrome (1983), with music by Howard Shore. Shore's conceptual response to Videodrome's reality-busting narrative was to blend a small string ensemble with synthesised orchestrations, using a new computer instrument called the Synclavier. The resulting ambiguity perfectly mirrors the film's unsettling philosophical core. Are the characters having real experiences or simulations? Are these real instruments, or artificial? In neither case can you ever quite tell. Shore continues to exert a profound influence on the art of horror, and while his imitators rarely capture the same gravity and power, it's not unusual for cut-price composers to mimic his solemn, glowering cello chords and shimmering microtonal violins.

Grunge, goth, metal and skate-punk have been regular party guests in horror ever since the release of Dan O'Bannon's The Return of the Living Dead (1985), a pastiche of George Romero's zombie films which added the Cramps and the Damned to the menu. At around the same time, corporate "synergy" was born; by the 1990s, soundtracks of all kinds were treated like foie gras ducks: stuffed with pop and rock in the hope that the album might shift enough units to reach the charts. The marketing wet dream was the Flashdance LP, which sold 700,000 in its first two weeks and went to No 1 in the US album chart. (No wonder Videodrome flopped, you can imagine the studio saying; who wants to do their morning calisthenics listening to Howard Shore's Pins and Needles?) For me, though, plastering rock and pop songs on to a horror soundtrack merely normalises that most precious component: mood. Besides, I want to experience a director's vision in sound, not listen to his crappy mix tape.

If I were asked what's needed today, I'd say innovation, and greater timbral variety. If you truly want the audience to experience the clammy thrill of the grotesque, the uncanny and the fearful, you have to reach for the unfamilar, the perplexing, even the ugly; there's an infinite Lovecraftian sound-world out there waiting to be explored. We need new combinations, new textures in film scoring. Horror has a licence to be weird – it's supposed to mess with our heads. Comfort-zone rock and respectable string arrangements be damned; what we need is a neat draft of madness.

• Stephen Thrower talks about the Sound of Fear as part of the Vision Sound Music festival (2-4 September) at London's Southbank Centre on 3 September. Details: soundandmusic.org