Migraine headaches are relatively common, affecting approximately 5% of all children. Although the differential diagnosis is extensive, a complete history and physical will usually lead to the correct diagnosis without laboratory or radiologic studies for most children. In cases of migraine complicated by neurologic problems, such as hemiplegia or ophthalmoplegia, neuroradiologic studies may be helpful to establish the diagnosis of complicated migraine. Treatment of migraine in children consists primarily of avoidance of triggers, rest, and simple analgesics. Behavior therapy, including relaxation-response training, has been shown to be an effective adjunct in managing both the frequency and intensity of the migraine attack. Use of pharmacologic agents for abortive and prophylactic therapy has not been extensively supported by well-designed, well-controlled research. In general, use of these agents should be restricted to the small group of children with frequent, severe attacks. Sumatriptan, a 5-HT1 receptor agonist, has shown promise in adult patients but future gains in treatment will be achieved only after a better understanding of the cause and pathogenesis of migraine.