A history of headaches in a family is very frequently noted when evaluating a child for recurrent, episodic headaches. Oftentimes, these headaches have migraine features, although the family may deny a history of migraine. This positive family history implies an inherited or genetic basis as a component to the underlying pathophysiology of primary headaches. A variety of methodology has begun to elucidate this contribution, including historical observation, population-based studies of families and twins, gene polymorphism association studies, and specific gene identification for isolated migraine subtypes. This line of investigation should progress in the future to a better understanding of migraine and clarification of the diagnostic subtypes for a genotype-phenotype association.