Epidemiologically, headaches are common in children. In order to ascertain the type of headache problems that result in a referral by pediatricians to a pediatric neurology clinic, the charts were reviewed of all patients evaluated in 1978 with the diagnosis of headache.A chief complaint of headache was given in 116 (22%) of all new patients evaluated. Final diagnostic groups were migraine headaches or variants (47%), tension headaches (28%), seizure equivalent (15%) and miscellaneous (10%). Almost two thirds of the patients were female. The mean ages of the seizure equivalent group and the tension headache group were similar, 9.3 and 9.5 years respectively. The migraine group was older with a mean age of 9.8 years. Of the 54 patients with migraine headaches, 78% were characterized as common migraine. This evaluation of the migraine patients differed from that of patients considered to have seizure equivalents on the basis of family history (63% vs 12%), abnormalities noted on neurological examination (7% vs 24%) and EEG abnormalities (20% vs 84%). Abnormalities in the tension headache group were less than 10% in all three categories evaluated.Although some overlaps exist, these data suggest a bimodel curve with migraine headaches and recurrent seizures at the extreme ends of the spectrum rather than a single entity with varying manifestations. Historically, the family history is the most distinguishing characteristic, but abnormalities on neurological evaluation, especially the EEG, were considered more significant factors in arriving at a diagnosis.