Objective <p>The aim of the study was to investigate whether atherosclerosis and cardiovascular disease risk are elevated in patients with migraine. To this end, epicardial fat, carotid intima-media thickness, carotid distensibility, and strain were measured and compared between migraine patients and healthy volunteers.</p> Methods <p>The study was designed as a cross-sectional. A total of 174 patients (103 migraine without aura and 71 migraine with aura) and 91 healthy volunteers were included. The study evaluated whether there were significant differences between the groups in epicardial fat, carotid intima-media thickness, carotid distensibility and strain, and examined their correlations with disease duration and headache days per month.</p> Results <p>Epicardial fat, carotid intima-media thickness, distensibility, and strain differed significantly among the three groups ( <i>p</i> = 0.006, <i>p</i> = 0.011, <i>p</i> = 0.006 and <i>p</i> = 0.023 respectively). Both migraine groups (with and without aura) showed significant differences in epicardial fat thickness and carotid distensibility compared to controls ( <i>p</i> = 0.002, <i>p</i> = 0.028 and <i>p</i> = 0.043, <i>p</i> = 0.008 respectivly). Carotid intima-media thickness and strain were significantly different only between the migraine without aura group and controls ( <i>p</i> = 0.02 and <i>p</i> = 0.025 respectively), with no significant difference observed for the migraine with aura group ( <i>p</i> = 0.883 and <i>p</i> = 0.184 respectively). In both migraine groups, these vascular parameters were significantly correlated with disease duration and headache days per month (<i>p</i> &lt; 0.05).</p> Conclusion <p>The study findings suggest that patients diagnosed with migraine may exhibit early signs of subclinical atherosclerosis. This increased risk appears to be more closely associated with the duration and severity of the disease, rather than the presence of aura.</p>