Most of the psychological and medical literature on childhood headache focuses on migraine headache. Very little research exists on the assessment and treatment of muscle-contraction (MCH) in children. The present paper reviews current ideas on what constitutes a MCH in children, pathophysiology, prevalence, and assessment and treatment approaches. The medical and psychological literature indicates childhood MCH is similar to adult MCH. MCH is believed to be caused by psychological or stress-related factors; however, only a few studies have addressed this issue with children. Questions remain as to what psychological factors to assess, and the best approach with children. Difficulties exist in obtaining reliable accounts of stressful events as well as headache symptoms. Pain diaries or questionnaires completed during the head pain may prove useful. Several studies have evaluated the use of EMG biofeedback and/or relaxation training with children MCH sufferers. Results are encouraging but methodological shortcomings prohibit firm conclusions. It is concluded that further research with childhood MCH is warranted in order to obtain a more complete medical and psychological understanding. Furthermore, this information is useful in differential diagnosis and for effective intervention in a chronic pain condition.