Migraine, particularly migraine with aura, is associated with an increased risk of ischemic stroke, but whether migraine is associated with other ischemic vascular events is not clear. In an analysis of data from a prospective study of healthy middle-aged women, Kurth and colleaguesArticle examined the association of migraine with subsequent risk of overall and specific cardiovascular disease (CVD). The authors found that compared with women with no migraine history, any history of migraine was associated with increased risk of CVD. Active migraine with aura was associated with increased risks of major CVD, ischemic stroke, myocardial infarction, death from ischemic CVD, coronary revascularization, and angina, whereas active migraine without aura was not associated with increased risk of these CVD events. In an editorial, Lipton and BigalArticle discuss possible explanations for these findings and their clinical implications.