We analyzed the history, physical examination findings, and skull roentgenograms of 72 children with headaches secondary to brain tumors to determine distinguishing features. Of 56 children, skull roentgenograms were abnormal in 54% (30). Abnormal findings from either the neurologic or ocular examination were present in 68 (94%) of these children at the time of brain tumor diagnosis. These abnormalities developed in 51 of 60 children (85%) within two months of the onset of their headaches. Clues for earlier diagnosis were frequently present in those patients whose conditions were diagnosed more than four months after the onset of their headaches. Recognition of those findings could have resulted in the diagnosis of brain tumor in 69 of 72 children (96%) within four months of the onset of headaches. During the first four months of headache complaints, children should be monitored closely.