We discuss the observed multiplicity of massive stars and implications on theories of massive star formation. After a short summary of the literature on massive star multiplicity, we focus on the O-and B-type stars in the Orion Nebula Cluster, which constitute a homogenous sample of very young massive stars. 13 of these stars have recently been the targets of a bispectrum speckle interferometry survey for companions. Considering the visual and also the known spectroscopic companions of these stars, the total number of companions is at least 14. Extrapolation with correction for the unresolved systems suggests that there are at least 1.5 and perhaps as much as 4 companions per primary star on average. This number is clearly higher than the mean number of ∼ 0.5 companions per primary star found for the low-mass stars in the general field population and also in the Orion Nebula cluster. This suggests that a different mechanism is at work in the formation of high-mass multiple systems in the dense Orion Nebula cluster than for low-mass stars.