Stroke Risk Reduction in Migraine Patients Using Propranolol: Evidence from Two Large-Scale Real-World Data Analyses

Area of Science:

• Neurology
• Cardiovascular Medicine
• Pharmacology

Background:

• Propranolol, a non-selective beta-blocker, is widely used for migraine prevention.
• The effect of propranolol on stroke risk in migraine patients is not well-established.
• Controversy exists regarding propranolol's impact on stroke risk in this population.

Purpose of the Study:

• To investigate the association between propranolol use and stroke risk in migraine patients.
• To compare stroke risk in migraine patients with and without documented propranolol use.
• To stratify the analysis by sex and migraine subtype.

Main Methods:

• Retrospective case-control study using electronic health records from two large datasets (VUMC and All of Us).
• Migraine patients identified using ICHD-3 criteria; cases had stroke post-migraine diagnosis, controls did not.
• Logistic regression and Cox proportional hazards models were used to assess stroke risk associated with propranolol use, adjusted for confounders.

Main Results:

• Propranolol use was associated with significantly reduced stroke risk in female migraine patients (VUMC: OR=0.52; All of Us: OR=0.39).
• This protective effect was more pronounced for ischemic stroke and in females with migraines without aura (MO).
• Longitudinal analysis showed consistently lower stroke rates in propranolol-treated female migraine patients over 10 years.

Conclusions:

• Propranolol is linked to a significant reduction in stroke risk, particularly ischemic stroke, in female migraine without aura patients.
• Findings suggest propranolol may be a beneficial agent for stroke prevention in select high-risk migraine populations.
• Further research may elucidate the precise mechanisms and optimal use of propranolol for stroke risk reduction in migraine.