This chapter reviews vascular comorbidities of migraine, potential clinical characteristics, and underlying etiologies. Migraine may be comorbid with disorders of the cerebrovascular, cardiovascular, and peripheral vascular systems and may be associated with vascular complications. Moreover, the risk of ischemic stroke, transient ischemic attack, and hemorrhagic stroke may be elevated in patients with migraine regardless of other risk factors. Neuroimaging studies may reveal asymptomatic silent structural lesions and white matter hyperintensities; symptomatic migrainous infarct is rare. Female-specific considerations including increased risk with exogenous estrogen intake, pregnancy, and peripartum. When formulating a plan for preventive and abortive migraine management, the individual’s risk of future vascular events based on prior history and risk factors must be considered. Many of the evidence-based migraine preventive and abortive medications have implications for migraine patients with comorbid vascular disease.