Information on the prevalence and health burden of headache in Africa is scanty. Earlier studies in the 1970s suggested that migraine was a rare condition in the African. This may have been due to an underdiagnosis because in less educated and rural African communities headache is considered a relatively trivial condition compared to other more basic and demanding socio-economic problems. More recent community-based studies put the prevalence rates of migraine between 3%–6.9%. The one-year prevalence of chronic tension-type headache in one African study was 1.7%. A review of the published literature reveal that cluster headache is extremely rare in the African. The clinical features of migraine in the African are similar to those described among Caucasians. However classical migraine appears to be rare in the African. Hot climate particularly exposure to the sun and physical and emotional stress were found to be the most common trigger factor for migraine attacks. Few African migraineurs use specific medications. The majority opt for traditional and herbal therapies. It is to be emphasized that there is a big need to undertake well planned epidemiological studies on headache in African populations using the International Headache Society Criteria with particular emphasis on health facility utilization and sickness absence from work.