Recently, climate models forced by the observed history of tropical Pacific SSTs have been able to successfully simulate all of the major North American droughts of the last 150 years. In each case, cool ’La Niña-like’ conditions in the tropical Pacific are consistent with North American drought.With ENSO showing a pronounced signal in the gridded drought reconstructions of the last millennium, both in terms of its link to the leading spatial mode, and the leading timescales of drought variability (revealed by multi-taper spectral analysis and wavelet analysis), we postulate that, as for the modern day, the Medieval mega-droughts were forced by protracted La Niña-like tropical Pacific SSTs. Further evidence for this comes from the global hydroclimatic ’footprint’ of the Medieval era revealed by existing paleoclimatic archives from the tropical Pacific and ENSO-sensitive tropical and extra-tropical land regions. In general, this global pattern matches that observed for modernday persistent North American drought, whereby a La Niña-like tropical Pacific is accompanied by hemispheric, and in the midlatitudes, zonal, symmetry of hydroclimatic anomalies.