OBJECTIVE: To study the diagnosis and differential diagnosis of childhood paroxysmal headache. METHODS: The clinical data of 122 children with paroxysmal headache, including the case history, manifestation and physical examination, electroencephalography (EEG), video electroencephalography (V EEG) and transcranial Doppler (TCD) findings, were studied retrospectively.RESULTS: Migraine was found in 85 of the 122 patients, nervous headache in 35, headache epilepsy in 1, and intracranial tumour in 1. Most patients displayed normal EEG and V EEG; the others showed mainly an increase of diffused inactive echoes in EEG and only 1 showed scattered epileptic waves. The TCD of 74 patients showed a significant increase of cerebral blood flow velocity. CONCLUSIONS: Migraine and nervous headache are frequent causes of childhood paroxysmal headache. Diagnosis should be made based on clinical manifestations, EEG and TCD findings. Headache epilepsy is a rare clinical condition and it is not reliable to make a diagnosis of childhood epilepsy for the child who only has heahache as the chief complaint.