Abstract Background It is unknown if ocular migraine patients have an increased risk of cerebrovascular disease. This study aimed to determine if cerebrovascular and cardiovascular events were elevated among those with ocular migraine compared to controls. Methods This cohort study utilised a platform of aggregate, de-identified electronic health record data to identify patients with a diagnostic code for ocular migraine based on ICD codes ( n = 21,949). Ocular migraine patients were compared to ophthalmology ( n = 1,492,348), migraine with aura (MA) ( n = 129,099) and migraine without aura (MO) controls. Cohorts were propensity score matched on current age, sex, race/ethnicity, diabetes, essential hypertension, lipoprotein disorders, atherosclerosis and body mass index. Risk ratios and 95% confidence intervals were calculated. A risk ratio between 0.9 and 1.1 was considered not significant. Results Compared with ophthalmology controls ≥ 50 years old, patients with a diagnostic code ocular migraine had an increased risk of all outcomes, with a risk ratio of 1.48 (95% CI 1.33, 1.64), transient ischemic stroke 2.68 (2.20, 3.27) and cerebral infarct 1.81 (1.55, 2.10). These findings continued to be significant among the ≥ 65 years old cases and controls. Compared to patients with MA or MO, patients had a comparable risk of all outcomes ( p > 0.05). Conclusion Patients with a diagnostic code for ocular migraine ≥ 50 years old had a 48% increased risk of cerebrovascular and cardiovascular outcomes, compared to ophthalmology controls. Future retrospective and prospective cohort analyses are needed to further verify these findings.