The association between tension-type headache and cognitive ability was assessed among 971 members of a longitudinal birth cohort study. Primary headache status was determined at age 32 years according to 2004 International Headache Society criteria, frequent childhood headaches were identified from parent report from ages 7 to 13 years, and data relating to cognitive and academic performance from ages 3 to 32 years were analyzed. Adult study members with tension-type headache did not score worse on any of the cognitive measures relative to headache-free controls or headache-free tinnitus sufferers. Instead, a consistent relation was found between childhood headache (regardless of headache diagnosis in adulthood) and lower scores on most cognitive measures from age 3 years through adolescence (verbal and performance IQ, receptive language, and reading scores). The data indicate that cognitive performance deficits in childhood headache sufferers can probably be attributed to factors stemming from utero or early childhood.