Pulsation effect on heat transfer in laminar incompressible flow, which led to contradictory results in previous studies, is theoretically investigated in this work starting from basic principles in an attempt to eliminate existing confusion at various levels. First, the analytical solution of the fully developed thermal and hydraulic profiles under constant wall heat flux is obtained. It eliminates the confusion resulting from a previously published erroneous solution. The physical implications of the solution are discussed. Also, a new time average heat transfer coefficient for pulsating flow is carefully defined such as to produce results that are both useful from the engineering point of view, and compliant with the energy balance. This rationally derived average is compared with intuitive averages used in the literature. New results are numerically obtained for the thermally developing region with a fully developed velocity profile. Different types of thermal boundary conditions are considered, including the effect of wall thermal inertia. The effects of Reynold and Prandtl numbers, as well as pulsation amplitude and frequency on heat transfer are investigated. The mechanism by which pulsation affects the developing region, by creating damped oscillations along the tube length of the time average Nusselt number, is explained.