Background: Headaches associated with pituitary adenoma have been reported to be related to the structural characteristics and endocrine factors of the tumour itself. Objectives: The objective of this study was to investigate the prevalence and clinical characteristics of, and the risk factors for, non-functioning pituitary adenoma (NFPA)-associated headaches in Chinese patients with normal endocrine activity. Methods: Ninety-seven patients with a NFPA with normal endocrine laboratory results were prospectively enrolled in this study. The relevant clinical demographic data were collected and examined with the appropriate statistical methods. Results: The pre-operative prevalence of tumour-associated headaches was 48.5%; 87.2% of these patients had migraine-like headaches. A family history of primary headache (odds ratio (OR) 3.67; p=0.032) and a higher tumour Knosp grade (OR 1.83; p=0.001) were identified as risk factors for the occurrence of NFPA-associated headaches. The patient's age, sex, visual disturbances, optic chiasm compression, tumour size and tumour volume were not significantly associated with NFPA-associated headaches (p>0.05). In addition, headache severity was significantly correlated with the Knosp grade (r=0.339; p=0.001). The sides of the headaches and of cavernous sinus invasion were significantly concordant (48.9% agreement; kappa=0.257; p=0.007). Conclusions: Migraine-like headaches are a common clinical manifestation in patients with NFPAs. A family history of primary headaches and cavernous sinus invasion are risk factors for NFPA-associated headaches.