Migraine and cerebrovascular disorders are comorbid diseases and the overlap of their clinical symptoms has relevant diagnostic and therapeutic implications. The prototypic condition of this relationship is reproduced by a clinical event named migrainous infarction (MI), listed by the ICHD-II among the "complication of migraine." We discuss the diagnostic criteria proposed for this rare condition with regard to the epidemiological studies and the clinicopathogenetic implications. In the clinical setting therefore, "possible" cases of migrainous infarction should undergo an extended diagnostic workup to rule out symptomatic migraine due to extra/intra-cranial vascular pathology (artery dissection/malformations, venous thrombosis) and to exclude a causal role for other conditions. These include patent foramen ovale and thrombophylic status that may become critical risk factors for stroke, particularly among migraineurs, in coincidence with precipitating factors that should be more accurately considered in each single case.