Although Atlantic hurricane risk is expected to increase in a warming climate, projecting trends in hurricane frequency over the present century is still highly uncertain. The short instrumental record limits our understanding of hurricane activity and its relationship to climate, especially on multi-decadal and longer time scales. Here we extend the instrumental hurricane frequency record using two independent sources of information: (1) a reconstruction of basin-wide Atlantic hurricane frequency over the last millennium, developed from sedimentary paleohurricane records; (2) a statistical model of hurricane activity using sea surface temperatures (SSTs) from the Last Millennium Reanalysis (LMR) datasets. We find statistically significant agreement between the two estimates, suggesting that a robust climate signal of hurricane frequency over the past millennium can be captured from proxy data. Neither estimate of hurricane frequency indicates that the late 20th century hurricane frequency is outside the range seen over the past millennium. Numerical simulations using a hurricane-permitting climate model suggest that hurricane activity over the last millennium was likely driven by endogenous climate variability and linked to anomalously warm SSTs over the Atlantic Main Development Region (MDR) as well as cold phases of Interdecadal Pacific Oscillation (IPO) SSTs. The forced signal estimated from the Last Millennium Ensemble (LME) project suggests that volcanic eruptions can induce peaks in hurricane activity, but such peaks would likely be too weak to be detected from reconstruction records due to large endogenous variability.