The "gold standard" in the diagnosis of pediatric migraine includes personal history, clinical and neurological examination. Many important data on previous morbidity, psychosocial status and recent sickness (today's headache) can be found by using an interview, "face to face", or by "headache diary". On clinical examination, it is important to pay due attention to cardiovascular and respiratory systems as well as to examination of the skin. Thorough neurological examination may reveal disturbances of the mental status, cranial nerves, motor and sensory systems, reflexes, coordination and visual status. Acute headache without febrile illness and neurological disturbances is very indicative on childhood migraine or "migraine variants". However, due to many secondary headaches with migraine-like symptoms, it is important to perform detailed diagnostic protocol including computerized tomography, magnetic resonance imaging, electroencephalography, transcranial color doppler, laboratory tests and toxicological screening. Neuroimaging is indicated in children with acute headache, chronic progressive headache, especially if associated with vomiting, nausea or neurological disturbances, papillary edema, and in children with personality changes, learning difficulties and those under five years of age.