diff --git a/clang-tools-extra/include-cleaner/lib/Record.cpp b/clang-tools-extra/include-cleaner/lib/Record.cpp
--- a/clang-tools-extra/include-cleaner/lib/Record.cpp
+++ b/clang-tools-extra/include-cleaner/lib/Record.cpp
@@ -83,14 +83,54 @@
       recordMacroRef(MacroName, *MI);
   }
 
+  void Ifdef(SourceLocation Loc, const Token &MacroNameTok,
+             const MacroDefinition &MD) override {
+    if (!Active)
+      return;
+    if (const auto *MI = MD.getMacroInfo())
+      recordMacroRef(MacroNameTok, *MI, RefType::Ambiguous);
+  }
+
+  void Ifndef(SourceLocation Loc, const Token &MacroNameTok,
+              const MacroDefinition &MD) override {
+    if (!Active)
+      return;
+    if (const auto *MI = MD.getMacroInfo())
+      recordMacroRef(MacroNameTok, *MI, RefType::Ambiguous);
+  }
+
+  void Elifdef(SourceLocation Loc, const Token &MacroNameTok,
+               const MacroDefinition &MD) override {
+    if (!Active)
+      return;
+    if (const auto *MI = MD.getMacroInfo())
+      recordMacroRef(MacroNameTok, *MI, RefType::Ambiguous);
+  }
+
+  void Elifndef(SourceLocation Loc, const Token &MacroNameTok,
+                const MacroDefinition &MD) override {
+    if (!Active)
+      return;
+    if (const auto *MI = MD.getMacroInfo())
+      recordMacroRef(MacroNameTok, *MI, RefType::Ambiguous);
+  }
+
+  void Defined(const Token &MacroNameTok, const MacroDefinition &MD,
+               SourceRange Range) override {
+    if (!Active)
+      return;
+    if (const auto *MI = MD.getMacroInfo())
+      recordMacroRef(MacroNameTok, *MI, RefType::Ambiguous);
+  }
+
 private:
-  void recordMacroRef(const Token &Tok, const MacroInfo &MI) {
+  void recordMacroRef(const Token &Tok, const MacroInfo &MI,
+                      RefType RT = RefType::Explicit) {
     if (MI.isBuiltinMacro())
       return; // __FILE__ is not a reference.
-    Recorded.MacroReferences.push_back(
-        SymbolReference{Tok.getLocation(),
-                        Macro{Tok.getIdentifierInfo(), MI.getDefinitionLoc()},
-                        RefType::Explicit});
+    Recorded.MacroReferences.push_back(SymbolReference{
+        Tok.getLocation(),
+        Macro{Tok.getIdentifierInfo(), MI.getDefinitionLoc()}, RT});
   }
 
   bool Active = false;
diff --git a/clang-tools-extra/include-cleaner/unittests/RecordTest.cpp b/clang-tools-extra/include-cleaner/unittests/RecordTest.cpp
--- a/clang-tools-extra/include-cleaner/unittests/RecordTest.cpp
+++ b/clang-tools-extra/include-cleaner/unittests/RecordTest.cpp
@@ -7,12 +7,13 @@
 //===----------------------------------------------------------------------===//
 
 #include "clang-include-cleaner/Record.h"
+#include "clang/Basic/SourceLocation.h"
 #include "clang/Frontend/FrontendAction.h"
 #include "clang/Frontend/FrontendActions.h"
 #include "clang/Testing/TestAST.h"
 #include "clang/Tooling/Inclusions/StandardLibrary.h"
-#include "llvm/Support/VirtualFileSystem.h"
 #include "llvm/ADT/ArrayRef.h"
+#include "llvm/Support/VirtualFileSystem.h"
 #include "llvm/Support/raw_ostream.h"
 #include "llvm/Testing/Support/Annotations.h"
 #include "gmock/gmock.h"
@@ -217,6 +218,44 @@
   EXPECT_THAT(ExpOffsets, ElementsAreArray(MainFile.points("exp")));
 }
 
+TEST_F(RecordPPTest, CapturesConditionalMacroRefs) {
+  llvm::Annotations MainFile(R"cpp(
+    #define X 1
+
+    #ifdef ^X
+    #endif
+
+    #if defined(^X)
+    #endif
+
+    #ifndef ^X
+    #endif
+
+    #ifdef Y
+    #elifdef ^X
+    #endif
+
+    #ifndef ^X
+    #elifndef ^X
+    #endif
+  )cpp");
+
+  Inputs.Code = MainFile.code();
+  Inputs.ExtraArgs.push_back("-std=c++2b");
+  auto AST = build();
+
+  std::vector<unsigned> RefOffsets;
+  SourceManager &SM = AST.sourceManager();
+  for (const auto &Ref : Recorded.MacroReferences) {
+    auto [FID, Off] = SM.getDecomposedLoc(Ref.RefLocation);
+    ASSERT_EQ(FID, SM.getMainFileID());
+    EXPECT_EQ(Ref.RT, RefType::Ambiguous);
+    EXPECT_EQ("X", Ref.Target.macro().Name->getName());
+    RefOffsets.push_back(Off);
+  }
+  EXPECT_THAT(RefOffsets, ElementsAreArray(MainFile.points()));
+}
+
 // Matches an Include* on the specified line;
 MATCHER_P(line, N, "") { return arg->Line == (unsigned)N; }