Migraine with aura (MA) and migraine without aura (MO) are primary headaches prevalent in the general population that carry a substantial familial liability. There is a evidence for a role of genetic factors in migraine. In this paper we investigated if migraine with aura is a genetic illness by studying population-based familial and twin studies, familial hemiplegic migraine (FHM) and sporadic hemiplegic migraine (SHM). The scientific evidence shows significantly increased familial risk of MA and the significantly higher concordance rate of migraine with aura in monozygotic than dizygotic twin pairs. FHM, classified as a subtype of MA, shows an autosomal dominant transmission pattern and is due to mutations in three genes encoding for neuronal channel subunits. These FHM mutations, however, account for a minority of the FHM families and are not usually found in SHM or in the typical migraines MA/MO. This implies that the genetic predisposition to the typical migraines may be different. It is likely that typical migraine genes will be discovered in the future.