| Year | Won | Margin | Democratic | Republican | Total |
|---|---|---|---|---|---|
| 2024 | R | 4,025 | 19,684 | 23,950 | |
| 2020 | R | 4,866 | 20,284 | 25,395 | |
| 2016 | R | 4,280 | 19,747 | 24,665 | |
| 2012 | R | 5,646 | 17,590 | 23,636 | |
| 2008 | R | 9,525 | 12,655 | 22,643 | |
| 2004 | D | 14,002 | 12,611 | 26,770 | |
| 2000 | D | 13,611 | 11,005 | 24,935 | |
| 1996 | D | 14,126 | 7,160 | 23,495 | |
| 1992 | D | 17,358 | 8,212 | 28,082 | |
| 1988 | D | 16,339 | 9,976 | 26,416 | |
| 1984 | D | 15,817 | 11,869 | 27,812 | |
| 1980 | D | 14,878 | 10,550 | 25,720 | |
| 1976 | D | 14,320 | 9,178 | 23,691 | |
| 1972 | R | 9,513 | 12,535 | 22,200 | |
| 1968 | D | 11,663 | 8,911 | 22,526 | |
| 1964 | D | 14,140 | 7,078 | 21,253 | |
| 1960 | D | 13,039 | 9,956 | 22,995 | |
| 1956 | R | 11,466 | 11,678 | 23,185 | |
| 1952 | D | 12,761 | 9,778 | 22,576 | |
| 1948 | D | 11,423 | 8,097 | 19,642 | |
| 1944 | D | 9,757 | 8,092 | 17,897 | |
| 1940 | D | 12,160 | 8,985 | 21,161 | |
| 1936 | D | 11,382 | 8,210 | 19,603 | |
| 1932 | D | 12,686 | 7,914 | 20,674 | |
| 1928 | R | 7,930 | 9,386 | 17,335 | |
| 1924 | R | 5,835 | 7,059 | 13,540 | |
| 1920 | R | 5,619 | 7,911 | 13,622 | |
| 1916 | R | 3,414 | 4,212 | 7,699 | |
| 1912 | R | 2,583 | 2,777 | 6,192 | |
| 1908 | R | 2,208 | 3,467 | 5,769 | |
| 1904 | R | 1,935 | 2,486 | 4,495 | |
| 1900 | R | 1,979 | 2,290 | 4,300 | |
| 1896 | R | 1,900 | 2,141 | 4,073 | |
| 1892 | D | 1,534 | 1,333 | 2,895 | |
| 1888 | — | — | — | — | |
| 1884 | — | — | — | — | |
| 1880 | — | — | — | — | |
| 1876 | — | — | — | — |
Pike County, anchored by Pikeville in eastern Kentucky's coalfields, swung from a reliably Democratic stronghold in the early 2000s to an R+65 margin in 2024, tracking the broader realignment of white working-class Appalachian voters.
The 2008 election was the turning point, when the Republican candidate carried the county by fourteen points. The 2024 margin was sixty-five points, in line with the county's new direction.
The demographics suggest why. A population of 56,727, a 94% non-Hispanic-white share, and a median household income of $44,312 situate the county in the broader realignment patterns of recent cycles. The county's voting pattern over the last decade is most similar to that of Lincoln County and Wyoming County.