This chapter focuses on the complex relationship of migraine with stroke and the different mechanisms by which migraine can predispose to stroke. Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS), CADASIL, and mitral valve prolapse (MVP) are all associated with migraine or migraine like episodes and strokes or stroke-like episodes. There is a higher prevalence of migraine in patients with transient global amnesia. Stroke-like migraine attacks after radiation therapy (SMART) is a relatively new syndrome in which stroke-like migraine attacks occur as a late consequence of brain irradiation. Many of the transient episodes in cerebral reversible vasoconstriction syndrome resemble migrainous attacks. Cerebral hemorrhages occasionally are reported after a severe migraine attack. The posited explanation is that initially intense vasoconstriction during the migraine headache leads to ischemia of a local brain region with edema and ischemia of the small vessels perfused by the constricted artery.