Migraine headaches are common in children and adolescents, with a wide spectrum of clinical forms. The most frequent pattern in children is migraine without aura, characterized by attacks of frontal, pounding, nauseating headache lasting 1 to 72 hours. The spectrum of migraine with aura includes migraine with typical aura, hemiplegic migraine, and basilar-type migraine, all of which may manifest during early childhood and pose challenging diagnostic dilemmas. The periodic syndromes are a fascinating subset of migraine peculiar to extremely young children, which are viewed as "precursors" to more typical migraine and can be associated with frightening focal neurologic disturbances. Migraine treatment philosophy now embraces a balanced approach with biobehavioral interventions and acute and preventative pharmacologic measures. A growing body of controlled pediatric data is beginning to emerge regarding migraine treatment in children, lessening our dependence on extrapolated adult data.