With the finding of significant extracranial cerebral vascular disease in 60–70% of patients with transient ischemic attacks (TIA), increased emphasis has been placed on the early detection of extracranial vascular lesions by noninvasive methods. The Doppler Ophthalmic Test (DOT), introduced in 1970 is one such technique. DOT's are abnormal in a significant percentage of patients (5-12%) found not to have extracranial vascular disease by angiography. Three thousand DOT's performed in a 3 12 year period at the Hospital of Scripps Clinic were re-examined. 37.2% of the positive sonograms occurred in patients with severe vascular headaches. Since migrainous patients have altered vasomotor function, it is suggested that the abnormal DOT represents a significant degree of vasoconstriction in the internal carotid or ophthalmic arteries. It is suggested further that persistence of vasoconstriction is related to complicated migraine and may, in part, be responsible for the increased occurrence of stroke in migraine patients.