The virtual water flow scale and structure of grain in Northeast China were analyzed using multi-source data, and their impact on water resources pressure was assessed. The results show that from 1990 to 2022, the total amount of grain virtual water exported from Northeast China is 1652.003 billion m³, including 1260.478 billion m³ of green water and 391.525 billion m³ of blue water. Climate warming and economic interests jointly drive the scale and structure of the grain virtual water flow, and the water resources stress index caused by the grain virtual water flow rises from 0.47 to 0.87, and the stress level changes from moderate to severe. Northeast China should adjust the planting structure and promote the construction of water network projects in the light of water resources conditions. The central government needs to promote the integrated management and control of virtual and physical water resources to ensure food security and the sustainable use of water resources.