We reviewed the records of 4874 patients, aged 50 years and younger, who were seen at the Mayo Clinic, Rochester, Minn, from 1976 to 1980, and had received a diagnosis of migraine, migraine equivalent, or vascular headache. Twenty patients (16 females and four males) who had migraine-associated brain infarctions are described. The areas of infarction and corresponding angiographic abnormalities were most frequently in the distribution of the posterior cerebral artery. During a mean follow-up period of seven years, two patients had a second brain infarction. At last follow-up examination, 18 of the 20 patients had minimal or no functional impairment. For the period 1976 to 1979, we reviewed the available data on cerebral infarction for the Rochester, Minn, population aged 50 years or younger; 25% of all incidence cases of cerebral infarction were migraine associated.