Introduction: Stroke is the second leading cause of death globally, with more than 85% of deaths from stroke occurring in developing countries. It is also reported as the major sequel of head and neck irradiation and has not received the attention it deserves. The contribution of various risk factors to the burden of stroke worldwide is unknown, particularly in countries of low and middle income. We aimed to establish the association of known and emerging risk factors, the carotid intima–media thickness (IMT), with stroke in postradiotherapy patients with head and neck malignancies, also aimed to establish whether carotid IMT (cIMT) is an independent risk factor to predict future stroke. Material and Methods: The study recruited 501 subjects. 151 irradiated patients with head and neck malignancy, formed case group. Three hundred and fifty nonirradiated apparently healthy controls formed control group. Each group was subdivided into four subgroups on the basis of gender and presence or absence of classical atherogenic risk factors, i.e. totally 8 groups were structured. All subjects were measured for their cIMT by color Doppler, b-mode ultrasonography and were also made to complete a questionnaire to assess other cardiovascular risk factors. The Framingham score system was used to predict probability of stroke. Results: Study described higher values of cIMT and total points for risk factors in cases than in controls and the difference was again statistically significant (P = 0.0001). Discussion and Conclusion: CIMT clearly indicated to act as an independent risk factor to predict stroke and is suggested to be worked on to be incorporated in the Framingham score.