Treatment with propranolol, a non-selective beta-blocker medication widely used to prevent migraines, was associated with a significant reduction in the risk of ischaemic stroke in women with migraine, according to a preliminary study presented at ISC 2025.

“Migraine is an often-ignored risk factor for cardiovascular issues. Until recently, preventive treatments for people who have migraines were not available,” said lead author Dr Mulubrhan Mogos from Vanderbilt University School of Nursing in Nashville, Tennessee, US.

“Growing evidence suggests that migraine can increase the risk of ischaemic stroke … Many women suffer from migraines, and it’s important to note that propranolol may be beneficial for these women, particularly those who experience migraine without aura. This is an important discovery for those dealing with migraines,” Mogos noted.

Using data from VUMC* and the All of Us Research Program databases, the researchers conducted a retrospective case-control study involving patients with a primary diagnosis of ischaemic stroke after the first onset of migraine (cases: 356 [VUMC] and 256 [All of Us Research Program]) and the control subjects were those who did not develop an ischaemic stroke after a migraine diagnosis (controls: 15,231 and 6,590, respectively). [ISC 2025, abstract TMP22]

Among all first-line migraine medications, such as valproate, topiramate, metoprolol, timolol, or propranolol, the use of propranolol was associated with a significantly reduced risk of ischaemic stroke in female patients with migraine (VUMC: adjusted odds ratio [adjOR], 0.55; p=0.013 and All of Us Research Program: adjOR, 0.41; p=0.010), but not in males.

Notably, the protective effect of propranolol on ischaemic stroke was even more pronounced in women with migraine without aura (adjOR, 0.53; p=0.027 [VUMC] and adjOR, 0.28; p=0.006 [All of Us Research Program]).

In secondary analyses, women with migraine who were treated with propranolol had lower rates of ischaemic stroke at 10 years in both VUMC (0.9 percent vs 2 percent; adjusted hazard ratio [adjHR], 0.45; p=0.011) and the All of Us Research Program (0.9 percent vs 3.3 percent; adjHR, 0.29; p=0.048) databases compared with those who were not treated with propranolol.

“Overall, among various migraine treatments, propranolol was notably associated with a significant reduction in ischaemic stroke risk among female patients with migraine, particularly those without aura,” said Mogos.

“These findings suggest a potential dual benefit of propranolol in managing migraine and reducing stroke risk, highlighting the need for further prospective studies to confirm these results and potentially inform clinical practice,” he noted.