Propranolol – a high blood pressure and migraine prevention medication – has been shown to reduce the risk of ischemic stroke risk among women using the drug for migraine prevention.
Propranolol is a beta blocker medication used for treating high blood pressure and preventing migraines.
In this new study, the medication was shown to have a stronger protective effect for ischemic stroke risk in women with migraine, particularly those without aura. However, the medication did not have the same protective effect on men.
“Migraine is an often-ignored risk factor for cardiovascular issues. Until recently, preventive treatments for people who have migraines were not available,” said lead study author Mulubrhan Mogos, assistant professor at Vanderbilt University School of Nursing in Nashville, Tennessee.
“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.”
For the study, researchers reviewed more than three million electronic health records from two large databases. In separate analyses, researchers identified people with migraine who developed stroke and those with migraine who did not develop stroke (control group).
They then assessed whether the individuals were treated with propranolol for migraine and whether that treatment had impacted stroke risk.
“We initially looked at overall stroke and then ischemic stroke specifically. We refined our analysis further by controlling for possible confounders and found the association is significant and stronger for ischemic stroke,” Mogos said.
After adjusting for potential variables, such as demographics (age, sex, race), other conditions (high blood pressure, diabetes, etc.) and hormonal factors (use of birth control, pregnancy – considered separately for each woman) that might affect results the analysis also found that the risk of developing a stroke was 52 per cent lower for women taking the medication in one database analysis and 39 per cent lower in the other.
No stroke risk reduction was seen in men in either analysis group. Secondary analyses showed lower overall stroke rates in women taking propranolol at multiple time points in both databases.
“Our findings indicate that women and health care professionals should discuss the advantages of preventive migraine interventions. For under-resourced individuals who bear a greater burden from this condition and may lack access to new treatments, we must ensure these treatments are available to them. This approach can help reduce health disparities,” Mogos said.
“Migraine without aura may often be overlooked as a risk factor for stroke, especially in women, in whom previous literature has demonstrated that migraine is a stronger, more important risk factor compared with men.
“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. 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,” said Tracy Madsen, chair of the American Heart Association Clinical Cardiology (CLCD)/Stroke Women’s Health Science Committee and associate professor of emergency medicine at The University of Vermont. Madsen was not involved in the study.
“This study is a great example of the important information that can be gained by studying women and men separately – we can take advantage of known sex differences in stroke risk factors and move towards more personalized care.”
The main limitation is that this was a review of past data using electronic health records, which may introduce biases, such as misclassification errors from reliance on ICD codes (codes used to classify and report health conditions and diseases). These findings highlight the need for studies that look forward in time to confirm these results.
