The Medieval Climate Anomaly (MCA) was the most recent pre-industrial era warm interval of European climate, yet its driving mechanisms remain uncertain. We present here a 947-year-long multidecadal North Atlantic Oscillation (NAO) reconstruction and find a persistent positive NAO during the MCA. Supplementary reconstructions based on climate model results and proxy data indicate a clear shift to weaker NAO conditions into the Little Ice Age (LIA). Globally distributed proxy data suggest that this NAO shift is one aspect of a global MCA-LIA climate transition that probably was coupled to prevailing La Niña–like conditions amplified by an intensified Atlantic meridional overturning circulation during the MCA.