When a headache develops in a child or adolescent, both the patient and the parents may fear the presence of a brain tumor. However, most headaches are not a symptom of a serious neurological disease but are related to stress or migraine. In this article, headaches in relationship to neurological disorders are reviewed. The pathophysiology of head pain and increased intracranial pressure are reviewed. Methods used to evaluate patients suspected of harboring an intracranial abnormality include a thorough history, a carefully performed physical examination, and neuroimaging studies. This article reviews cerebrovascular disease, neoplasms, hydrocephalus, and other structural abnormalities that cause headaches.