Data show a firm association between migraine and stroke, especially migraine with aura. The exact mechanisms by which migraine can lead to stroke are still under investigation and are complex. Migraine is a neurovascular disorder mainly affecting women. Some of the proposed mechanisms are; association with cardiovascular risk factors, PFO and endothelial dysfunction. Migraine with aura is associated with increased risk for subclinical infarctions in the posterior fossa circulation on magnetic resonance imaging (MRI). There are no established strategies for prevention of stroke in migraineurs. However the absolute risk of stroke is low in patients with migraine with aura, and migraine without aura has not been associated with ischemic stroke. This review summarizes the epidemiological evidence of prevalence, possible mechanisms, predisposition in women and preventive therapy.