diff --git a/clang-tools-extra/clangd/SourceCode.h b/clang-tools-extra/clangd/SourceCode.h
--- a/clang-tools-extra/clangd/SourceCode.h
+++ b/clang-tools-extra/clangd/SourceCode.h
@@ -297,7 +297,8 @@
 /// aligned to the beginning of an identifier.
 llvm::Optional<DefinedMacro> locateMacroAt(const syntax::Token &SpelledTok,
                                            Preprocessor &PP,
-                                           const syntax::TokenBuffer &TB);
+                                           const syntax::TokenBuffer &TB,
+                                           bool UseLineDirectives = true);
 
 /// Infers whether this is a header from the FileName and LangOpts (if
 /// presents).
diff --git a/clang-tools-extra/clangd/SourceCode.cpp b/clang-tools-extra/clangd/SourceCode.cpp
--- a/clang-tools-extra/clangd/SourceCode.cpp
+++ b/clang-tools-extra/clangd/SourceCode.cpp
@@ -952,7 +952,8 @@
 
 llvm::Optional<DefinedMacro> locateMacroAt(const syntax::Token &SpelledTok,
                                            Preprocessor &PP,
-                                           const syntax::TokenBuffer &TB) {
+                                           const syntax::TokenBuffer &TB,
+                                           bool UseLineDirectives) {
   SourceLocation Loc = SpelledTok.location();
   assert(Loc.isFileID());
   const auto &SM = PP.getSourceManager();
@@ -971,6 +972,9 @@
     return None;
 
   SourceRange DefRange(MI->getDefinitionLoc(), MI->getDefinitionEndLoc());
+  if (!UseLineDirectives)
+    return DefinedMacro{IdentifierInfo->getName(),
+                        CharSourceRange::getTokenRange(DefRange)};
 
   // Macro definitions could be injected through preamble patch. These contain
   // line directives to hint their original location in main file.
diff --git a/clang-tools-extra/clangd/XRefs.cpp b/clang-tools-extra/clangd/XRefs.cpp
--- a/clang-tools-extra/clangd/XRefs.cpp
+++ b/clang-tools-extra/clangd/XRefs.cpp
@@ -751,7 +751,7 @@
   if (const auto *IdentifierAtCursor =
           syntax::spelledIdentifierTouching(*CurLoc, AST.getTokens())) {
     Macro = locateMacroAt(*IdentifierAtCursor, AST.getPreprocessor(),
-                          AST.getTokens());
+                          AST.getTokens(), false);
   }
 
   RefsRequest Req;
diff --git a/clang-tools-extra/clangd/unittests/PreambleTests.cpp b/clang-tools-extra/clangd/unittests/PreambleTests.cpp
--- a/clang-tools-extra/clangd/unittests/PreambleTests.cpp
+++ b/clang-tools-extra/clangd/unittests/PreambleTests.cpp
@@ -10,13 +10,16 @@
 #include "Compiler.h"
 #include "Headers.h"
 #include "Preamble.h"
+#include "SourceCode.h"
 #include "TestFS.h"
 #include "TestTU.h"
+#include "XRefs.h"
 #include "clang/Frontend/PrecompiledPreamble.h"
 #include "clang/Lex/PreprocessorOptions.h"
 #include "llvm/ADT/STLExtras.h"
 #include "llvm/ADT/StringExtras.h"
 #include "llvm/ADT/StringRef.h"
+#include "llvm/Support/Error.h"
 #include "llvm/Support/MemoryBuffer.h"
 #include "llvm/Support/VirtualFileSystem.h"
 #include "gmock/gmock.h"
@@ -28,6 +31,7 @@
 
 using testing::Contains;
 using testing::Field;
+using testing::Matcher;
 
 namespace clang {
 namespace clangd {
@@ -338,6 +342,48 @@
   EXPECT_THAT(FoundMacro->Name, "FOO");
 }
 
+TEST(PreamblePatchTest, RefsToMacros) {
+  struct {
+    llvm::StringLiteral Baseline;
+    llvm::StringLiteral Modified;
+  } Cases[] = {
+      // Newly added
+      {
+          "",
+          R"cpp(
+            #define ^FOO
+            ^[[FOO]])cpp",
+      },
+      // Moved around
+      {
+          "#define FOO",
+          R"cpp(
+            #define BAR
+            #define ^FOO
+            ^[[FOO]])cpp",
+      },
+  };
+
+  for (const auto &Case : Cases) {
+    Annotations Modified(Case.Modified);
+    auto AST = createPatchedAST("", Modified.code());
+    ASSERT_TRUE(AST);
+
+    const auto &SM = AST->getSourceManager();
+    std::vector<Matcher<Location>> ExpectedLocations;
+    for (const auto &R : Modified.ranges())
+      ExpectedLocations.push_back(Field(&Location::range, R));
+
+    for (const auto &P : Modified.points()) {
+      auto *MacroTok = AST->getTokens().spelledTokenAt(SM.getComposedLoc(
+          SM.getMainFileID(),
+          llvm::cantFail(positionToOffset(Modified.code(), P))));
+      ASSERT_TRUE(MacroTok);
+      EXPECT_THAT(findReferences(*AST, P, 0).References,
+                  testing::ElementsAreArray(ExpectedLocations));
+    }
+  }
+}
 } // namespace
 } // namespace clangd
 } // namespace clang