Our aim was to assess the 1-year prevalence of migraine headache in a rural population within the catchment area of the Haydom Lutheran Hospital in northern Tanzania. From December 2003 until June 2004 a community-based door-to-door survey was carried out, using a questionnaire based on the criteria of the International Headache Society, including 1192 households with 7412 individuals selected by multistage cluster-random sampling. The overall 1-year prevalence of migraine headache was found to be 4.3% [316/7412, 95% confidence interval (CI) 3.8, 4.7] with an age-adjusted rate of 6.0% and a male : female ratio of 1:2.94 (P < 0.001). Of these individuals, 132 did not fulfil all criteria for migraine headache, hence, these patients had to be classified as migrainous disorders with a crude prevalence rate of 1.8% (132/7412. 95% CI 1.5, 2.1). The remaining 184 patients met all criteria for migraine resulting in a 1-year prevalence of 2.5% (184/7412, 95% CI 2.1, 2.9) and a male : female ratio of 1:2.51 (P < 0.001). The present survey shows that migraine headache is not uncommon in northern Tanzania. The recorded prevalence of migraine headache is located within the median of previous African prevalence surveys, which confirms the trend of lower migraine frequencies in rural Africa compared with western countries.