Propranolol may lower stroke risk in women with migraines

Propranolol may lower stroke risk in women with migraines | Image Credit: © goodluz - © goodluz - stock.adobe.com.

Propranolol, a beta blocker medication designed to manage high blood pressure and reduce the risk of migraines, has been linked to reduced odds of ischemic stroke, according to a recent study to be presented at the American Stroke Association’s International Stroke Conference 2025 between February 5 and February 7, 2025.¹

The medication was linked to a reduced risk of ischemic stroke in women, but not men, when used for the prevention of migraines. This effect was particularly reported in cases of migraine without aura.¹

“Migraine is an often-ignored risk factor for cardiovascular issues.” said lead study author Mulubrhan Mogos, PhD, MSc, FAHA, from Vanderbilt University School of Nursing. “Until recently, preventive treatments for people who have migraines were not available.”¹

Women are 3 times more likely to report migraine headaches than men, which have been linked to an increased risk of stroke. In migraines with aura, patients may also experience blind spots, flashing lights, seeing colored spots, and zigzag patterns.¹

The analysis included over 300 million medical records and reported propranolol’s impact on ischemic stroke compared to other stroke types in both women and men with migraines.¹ Relevant variables included age, sex, race, diabetes, high blood pressure, pregnancy, and use of birth control.

Data was obtained from the Synthetic Derivative (SD) at Vanderbilt University Medical Center and the All of Us Research Program.² International Classification Disease codes were used to identify patients with migraine and stroke, with stroke cases determined by a primary diagnosis of stroke after the initial migraine onset.

Patients with no stroke diagnosis following migraine onset were included in the analysis as controls. The link between propranolol use and stroke risk was determined through logistic regression models.²

There were 378 cases and 15,209 controls in the SD database, vs 267 and 6579, respectively, in the All of Us database. Female patients with migraine were significantly less likely to experience stroke, with an odds ratio of 0.52 in the SD database and 0.39 in the All of Us database. This association was not found in male patients.²

Stronger effects were reported for ischemic stroke and in women with migraine without aura. This data was consistent across both databases.²

“These findings suggest that propranolol may be beneficial not only for migraine prophylaxis but also for stroke prevention in high-risk populations,” investigators wrote. “Further prospective studies are warranted to validate these results and inform clinical guidelines.²

According to Mogos, women from historically under-resourced communities are disproportionately impacted by migraines.¹ This may affect their ability to achieve educational goals or stable employment.

Mogos also noted the need for women and health care providers to discuss migraine prevention. To reduce health disparities, resources should be available for all patients, including those at risk of a greater disease burden.¹

“The study’s findings are not surprising since we have strong evidence that medications similar to propranolol used to treat blood pressure reduce stroke risk substantially,” said Tracy E. Madsen, MD, PhD associate professor of emergency medicine at The Robert Larner, MD College of Medicine.¹

“The findings are potentially quite helpful, though, for women living with frequent migraine, as they suggest we have a good medication option that helps to prevent both migraines and strokes,” added Madsen.¹

Additional data will be presented at the American Stroke Association’s International Stroke Conference 2025 in Los Angeles, California from February 5 to February 7, 2025.¹

References

1. Propranolol may reduce ischemic stroke risk in women with migraines. American Heart Association. January 30, 2025. Accessed February 3, 2025. https://www.eurekalert.org/news-releases/1071532?
2. Jeong E, Chen Y, Mogos MF. Propranolol's potential role in cutting stroke risk for patients with migraine: An in-depth analysis of two databases. Presented at: American Stroke Association’s International Stroke Conference 2025. Los Angeles, California, February 5-7, 2025.