Background: Migraine, particularly with aura, is a risk factor for early-onse t ischemic stroke. The underlying mechanisms are unknown, but may in part be due to migraineurs having an increased risk profile for cardiovascular disease. In this study,the authors compare the cardiovascular risk profile of adult migraine urs to that of nonmigraineurs. Methods: Participants(n = 5,755, 48%men, age 20 to 65 years) are from the Genetic Epidemiology of Migraine (GEM) study, a popula tion-based study in the Netherlands. A total of 620 current migraineurs were id entified: 31%with aura (MA), 64%without aura (MO),and 5%unclassified. Control s were 5,135 individuals without lifetime migraine. Measured cardiovascular risk factors included blood pressure (BP), serum total and high-density lipoprotein cholesterol (TC, HDD), smoking, oral contraceptive use, and the Framingham risk score for myocardial infarction or coronary heart disease (CHD) death. Results: Compared to controls, migraineurs were more likely to smoke (OR = 1.43[1.1 to 1 .8]), less likely to consume alcohol (OR = 0.58 [0.5to 0.7]), and more likely to report a parental history of early myocardial infarction. Migraineurs with aura were more likely to have an unfavorable cholesterol profile (TC 2 240 mg/dL [OR = 1.43 (0.97 to 2.1)], TC:HDL ratio > 5.0 [OR = 1.64 (1.1 to 2.4)]), have eleva ted BP (systolic BP > 140 mm Hg or diastolic BP > 90mm Hg [OR = 1.76 (1.04 to 3. 0)]), and report a history of early onset CHD or stroke (OR = 3.96 [1.1 to 14.3] );female migraineurs with aura were more likely to be using oral contraceptives (OR = 2.06 [1.05 to 4.3]). The odds of having an elevated Framingham risk score for CHD were approximately doubled for the migraineurs with aura. Conclusions: M igraineurs,particularly with aura, have a higher cardiovascular risk profile tha n individuals without migraine. Background: Migraine, particularly with aura, is a risk factor for early-onse ischemic stroke. The underlying mechanisms are unknown, but may in part be due to migraineurs having an increased risk profile for cardiovascular disease. In this study, the authors compare the cardiovascular risk profile of adult migraine urs to that of nonmigraineurs. Methods: Participants (n = 5,755, 48% men, age 20 to 65 years) are from the Genetic Epidemiology of Migraine (GEM) study, a popula tion-based study in the Netherlands. A total of 620 current migraineurs were idized: 31% with aura (MA), 64% without aura (MO), and 5% unclassified. Control s were 5,135 individuals without lifetime migraine. Measured cardiovascular risk factors included blood pressure (BP), serum total and high-density lipoprotein cholesterol (TC, HDD), smoking, oral contraceptive use, and the Framingham risk score for myocardial infarction or coronary heart disease (CHD) death. Results: Compared to controls, migraineurs were more likely to smoke (OR = 1.43 [1.1 to 1 .8]), less likely to consume alcohol (OR = 0.58 [0.5to 0.7]), and more likely to report a parental history of early myocardial infarction. Migraineurs with aura were more likely to have an unfavorable cholesterol profile (TC 2 240 mg / dL [OR = 1.43 (0.97 to 2.1)], TC: HDL ratio> 5.0 [OR = 1.64 (1.1 to 2.4) > 140 mm Hg or diastolic BP> 90 mm Hg [OR = 1.76 (1.04 to 3.0)]) and report a history of early onset CHD or stroke (OR = 3.96 [1.1 to 14.3]); female migraineurs with aura were more likely to be using oral contraceptives (OR = 2.06 [1.05 to 4.3]). The odds of having an elevated Framingham risk score for CHD were approximately doubled for the migraineurs with aura. Conclusions: M igraineurs, particularly with aura, have a higher cardiovascular risk profile tha n individuals without migraine.