Headache is a common symptom, often associated with disability, but rarely life threatening. However, even disabling migraine is under-diagnosed and under-treated. There are no diagnostic tests for migraine or tension-type headaches, and the history is all-important. A headache history requires time to elicit and a simple and helpful stratagem when the patient first presents in a clinic is to request the keeping of a diary over a few weeks. The pattern of attacks is a very helpful indicator of the right diagnosis. It must be ascertained first that a condition requiring more urgent intervention is not present. In this brief review, the crucial elements of a headache history are presented in detail, and key principles of treatment are described.