Thermal regimes in rivers and streams are fundamentally important to aquatic ecosystems and are expected to change in response to climate forcing as the Earth’s temperature warms. Description and attribution of stream temperature changes are key to understanding how these ecosystems may be affected by climate change, but difficult given the rarity of long-term monitoring data. We assembled 18 temperature time-series from sites on regulated and unregulated streams in the northwest U.S. to describe historical trends from 1980–2009 and assess thermal consistency between these stream categories. Statistically significant temperature trends were detected across seven sites on unregulated streams during all seasons of the year, with a cooling trend apparent during the spring and warming trends during the summer, fall, and winter. The amount of warming more than compensated for spring cooling to cause a net temperature increase, and rates of warming were highest during the summer (raw trend = 0.17°C/decade; reconstructed trend = 0.22°C/decade). Air temperature was the dominant factor explaining long-term stream temperature trends (82–94% of trends) and inter-annual variability (48–86% of variability), except during the summer when discharge accounted for approximately half (52%) of the inter-annual variation in stream temperatures. Seasonal temperature trends at eleven sites on regulated streams were qualitatively similar to those at unregulated sites if two sites managed to reduce summer and fall temperatures were excluded from the analysis. However, these trends were never statistically significant due to greater variation among sites that resulted from local water management policies and effects of upstream reservoirs. Despite serious deficiencies in the stream temperature monitoring record, our results suggest many streams in the northwest U.S. are exhibiting a regionally coherent response to climate forcing. More extensive monitoring efforts are needed as are techniques for short-term sensitivity analysis and reconstructing historical temperature trends so that spatial and temporal patterns of warming can be better understood. Continuation of warming trends this century will increasingly stress important regional salmon and trout resources and hamper efforts to recover these species, so comprehensive vulnerability assessments are needed to provide strategic frameworks for prioritizing conservation efforts.