Migraine has been established as a risk factor for ische-mic stroke. Further evidence suggests that migraine is also associated with other ischemic vascular events, including myocardial infarction and cardiovascular death. However, these associations appear to be limited to the subgroup of patients with migraine with aura (MA). Moreover, there is increasing evidence that among patients with MA, additional subgroups exist that carry particular increased risk. The association with ischemic stroke is, for example, particularly strong for younger women with MA who smoke and/or use oral contraceptives. Results from recent studies support an even more complex interrelationship characterized by additional modifying effects of other factors on the association between MA and ischemic vascular events. These include vascular risk factors, migraine attack frequency, and genetic variants. In addition, there appear to be differential effects with regard to ischemic stroke and myocardial infarction. These new findings await confirmation in independent patient populations and are currently not sufficient to argue for a change in diagnostic testing or treatment.