The West Virginia boys' high school basketball tournament began in Buckhannon on March 21, 1914. Since then more than 350 high schools have entered teams at some level of tournament play. Each spring the tournament city, Charleston in recent decades, takes on a holiday atmosphere as thousands of players and fans arrive from across the state.

The event was first sponsored by West Virginia Wesleyan College, which at the time had West Virginia's largest and finest gymnasium. Invitations were issued to Elkins and Wheeling, each of which claimed basketball supremacy in 1914. Elkins High emerged triumphant and became the first school to earn the title "state champions." In 1915, Wesleyan athletic director Harry Stansbury contacted high schools all over West Virginia, inviting them to participate in an open tournament for the state basketball title. Fourteen teams answered the call, and the building of a sports tradition was under way.

The number of participating schools began to climb as basketball's popularity took hold. In 1922, the field of 64 was broken into "A" and "B" divisions, classified according to team strength rather than school size. Several different plans for structuring the event were used before the tournament was completely reorganized in 1933. Under the new plan sectional winners would advance to eight regional tournaments. The regional champions, the "State Eight," would then meet in the conclusive event. From 1959 through 2019, a three-class format was used, based on school size, each class having eight teams in the tournament. Beginning in 2020-21, a fourth tier, Class AAAA, was added.

In 1939, after a 25-year run at Wesleyan College, the tournament was moved to Mountaineer Field House in Morgantown, which could better accommodate the growing crowds. Huntington Memorial Field House was the site for the 1955 event, largely in response to the argument that the southern part of the state be given the opportunity to host the tournament. The annual affair alternated between Morgantown and Huntington until 1965, when Charleston's Civic Center made it a three-way rotation. Charleston has hosted the meet since 1972, with the exception of 1979-80 when it was held in Morgantown while the original Charleston Civic Center (now Charleston Coliseum & Convention Center) was being expanded and renovated.

The preeminent school in tournament history is Woodrow Wilson of Beckley. As of 2024, the Flying Eagles had won 16 state titles all in the highest classification (A, AAA, or now AAAA). Among schools still active, Wheeling Central Catholic High School is a distant second with 10 in class A, followed by Parkersburg High with seven in class AAA. Now closed by consolidation, Northfork's Blue Demons attracted national attention with eight consecutive class AA crowns, and a total of 10 in a span of 18 years. Among the former giants no longer open, Wheeling won eight championships, old Huntington High seven, and Charleston six. Mullens, the only school to capture titles in three different classes, gathered seven of them before it was closed. Special mention must go to Hundred (1930) and Normantown (1945), small schools that won unclassified tournaments against all comers.

In March 2020, regional play for the 2019-20 season was suspended, and the state tournament was canceled due to the outbreak of the COVID-19 pandemic. As a result, no champion was crowned that year. The regional and state tournaments returned in 2021.