In 1919, three states—South Carolina, Oklahoma, and West Virginia—held state basketball tournaments for girls for the first time. The West Virginia tournament was the work of W. W. Lovell, principal of Spencer High School, and members of the Roane County board of education who decided to hold a tournament for girls to rival the boys tournament, which began in 1914 at West Virginia Wesleyan College. At the time, Spencer did not have a gym, so the organizers recruited carpenters and the high school shop class to build a gymnasium with enough space for 1,000 spectators.

Ten teams traveled by train to Spencer for the first tournament. Huntington High School won the tournament the first year, and Wheeling High School won the next three championships. Spencer and Pennsboro won the following two championships in 1923 and 1924.

The West Virginia Girls' Basketball Tournament had a successful run through 1924, drawing a high of 34 teams in 1922. But by 1924, critics were claiming that interscholastic sports were bad for girls' health. The West Virginia High School Athletic Association (forerunner of the West Virginia Secondary Schools Activities Commission) discontinued the tournament after a vote of 24-22.

Some West Virginia high schools continued to field girls' basketball teams through the 1920s. Spencer, Huntington, and Man high schools participated in the national girls' high school championship before it, too, was abolished in the late 1920s. By the late 1930s almost all of the girls' high school and college basketball teams had been disbanded.

The WVSSAC reestablished the girls' state basketball tournament in 1976, four years after the passage of Title IX, the federal act that mandated equal opportunities for female athletes. The 1976 tournament, played at West Virginia Wesleyan College, was won by Dunbar in Class AAA, Northfork in Class AA, and Fort Gay in Class A. The annual tournament is now played in Charleston, in the same venue as the boys tournament and one week earlier.

Mary Ostrowski (1962-2013) of Parkersburg Catholic, Vicky Bullett of Martinsburg, Alexis Hornbuckle of Capital and South Charleston, and Renee Montgomery of South Charleston are among the most successful players in the history of the girls' basketball tournament. Ostrowski was three-time girls' player of the year (1977-1979) while leading her team to three state championships. Bullett later played on the U.S. Olympic 1988 gold medal and 1992 bronze medal women's basketball teams and had a six-year career in the Women’s National Basketball Association (WNBA). After being named West Virginia state player of the year in 2004, Hornbuckle helped lead the University of Tennessee to two national championships and went on to a six-year career in the WNBA. Montgomery was a a high school All-American before leading the University of Connecticut to a national championship in 2009 and won two WNBA championships with the Minnesota Lynx. As an owner of the Atlanta Dream, Montgomery is the first former WNBA player to become a WNBA owner.

One of the most successful teams in recent years has been Huntington St. Joseph in Class A with seven straight championships through 2015, a record, and has added two more since (2017 and 2019). Two players from that school have earned Gatorade Player of the Year honors: Mychal Johnson (in both 2012-13 and 2013-14) and Grace Hutson (2019-20). Summers County High, with five straight championships between 2007 and 2011, holds the record for Class AA. Private schools dominated tournament play in Class A for more than a decade, until the Gilmer County Titans won in 2016.

Another successful team has been North Marion, which won three of four championships from 2009 through 2012, and another in 2018. Morgantown took the Class AAA champion three straight years: 2014-16. Since 2017, Huntington has won three championships in the highest class division, and Parkersburg has won two. In 2021, a fourth division, Class AAAA, was added for both boys and girls.

In March 2020, after nine games had been played, the girls' tournament for the 2019-20 was suspended after it was under way due to the COVID-19 pandemic outbreak. As a result, no champion was crowned that year. The tournaments resumed in 2021.