A fair portion of the diagnostic practice of the neurologist and ophthalmologist involves the deciphering of visual symptoms in patients known to have migraine, and many who at the time of their initial presentation do not. The most common visual disorder in this category, migraine with aura, has been studied extensively, but no conclusive evidence has been proven linking the visual aura, believed to result from a spreading depression, to the subsequent development of the cephalgia. Vasospasm remains controversial in the pathophysiology of migraine, but may play a role in patients who suffer more permanent or complicated neurovisual dysfunction. This paper reviews some of the current thoughts on the subject, and hopefully will stimulate the reader to explore the complex issue of this common malady.